In 2022, Hurricane Ian hit Florida, crashing through the state’s west coast near Fort Myers. It was one of the most powerful storms to ever hit the United States, causing more than 150 deaths and over $150 billion in damage. In the years that have followed, researchers have confirmed that human-caused climate change worsened the storm; rainfall increased by 18 percent.
While it raged, Jasmine McKenzie was outside of the storm path in another part of Florida. But as soon as the hurricane was over, she packed up a 15-passenger van with supplies and headed into the destruction it had wrought. The whole community was in need of disaster relief, but McKenzie knew there was one segment of the West Florida population that would be slipping through the cracks: trans people. McKenzie is a trans woman herself, and the executive director of the McKenzie Project, an organization serving Black trans, gender non conforming, and non-binary people in Florida, a state with some of the harshest anti-trans legislation in the U.S.
McKenzie delivered 57 generators, alongside clothes, foods, gas cards and other supplies to trans Floridians in the hurricane’s path because she knew they wouldn’t have access to other emergency resources. “There was a need specifically for trans people,” McKenzie says, since the community had fewer financial resources to gather supplies.
She also understood that trans folks could be turned away or face discrimination when trying to access emergency shelters without the correct documents, or with documents that don’t match their gender identity. In a highly publicized case after Hurricane Katrina, for example, a Black trans girl and woman, cousins, both evacuated to a shelter in College Station, Texas. There, they were arrested for using the women’s restroom.
“After disasters, queer, and especially transgender people of colour, are further criminalized,” says Michael Mendez, a professor at University of California, Irvine, who studies the impacts of disasters on marginalized communities. Most of the trans community—and the Black trans community in particular— “experience all these forms of hate and inequality, and they bring that into disasters. Legal, psychological and physical discrimination can be amplified in a disaster.”
A small but growing body of research addresses the intersection between trans identities and climate risk. A 2026 study in Population and Environment found that trans Ohioan respondents were several times more likely to experience the impacts of extreme heat or flooding than their cis male counterparts. “We found out that [trans] folks are more times likely to experience negative health outcomes related to these extreme weather events,” says Brandon Rothrock, one of the study’s co-authors.
Negative health outcomes ranged from physical wounds to respiratory infections or mental stress. Some were disaster-specific, such as experiencing heat stroke during extreme heat or an allergic reaction from mould growth after flooding. Rothrock and his team found that trans respondents were 3.5-3.8 times more likely to have a negative health outcome compared to cis men, depending on the disaster type.
In a follow-up study, Rothrock found that trans folks with disabilities were even more likely to face barriers than cis and non-disabled trans respondents. “Gender minority stress intensifies during climate disasters when pre-existing marginalization intersects with environmental hazards,” he explains.
The trans community is more vulnerable to climate disasters because they start from a more precarious place, Mendez, who has also published on the topic, says. Trans people have disproportionately high levels of homelessness. “Youth, particularly youth of colour, are disowned by their family, and they end up on the streets,” says Mendez, “so they have less access to medical [or mental health] care, and other social services. That’s further going to be exacerbated during disasters.”
The precarity is worsened by emergency services ill-prepared for or actively hostile to the trans community. In Canada, a 2023 study found that 41 percent of trans and gender-diverse respondents experienced judgment or discrimination at homeless shelters (no data was available on emergency shelters, specifically). South of the border, the 2022 U.S. National Transgender Survey found that 58 percent of trans people were denied access to shelters—homeless and emergency alike—due to their gender. Of those who were able to gain access, just over a quarter left after facing poor treatment. Since 2022, the situation in the U.S. has only worsened, as it has faced an unprecedented spread of anti-trans legislation, which increasingly limits trans people’s access to government services and public spaces.
Emergency support is also often supplemented by religious organizations who hold anti-LGBTQ2S+ views. Numerous studies, such as Mendez’s, have documented cases of religious disaster relief organizations discriminating against LGBTQ+ disaster victims. Such discrimination is sometimes legally permissible in the U.S. due to religious exemption laws, or—increasingly—due to federal changes under the Trump administration. Even if an organization is not taking discriminatory actions, disaster victims may have to contend with anti-LGBTQ2S+ rhetoric or volunteers in order to receive the services they need.
For example, Samaritan’s Purse, an evangelical disaster aid organization which recently provided flood relief in Ottawa, has a public “statement of faith” that asserts marriages are between a man and a woman and that people are either “biologically” male or female. Previously, they required volunteers to sign the statement. Ottawa city councillor Sean Devine told CBC that he was assured Samarian’s Purse helped everyone. Still, other local leaders and community members criticized the group’s presence in the city.
Without access to safe places or emergency services, people are forced into situations where they are actively unsafe, especially during a disaster. “It pushes people to risky behaviours,” McKenzie says, such as staying in areas with active flooding or staying outdoors during a lightning storm.
Even trans people with stable housing and incomes face added barriers to emergency relief. Research has shown that predominantly LGBTQ+ neighbourhoods are at higher risk for flooding and other climate impacts. Trans people have a higher rate of cardiovascular disease, which is worsened by exposure to wildfire smoke. And the dual impacts of discrimination and emergency stress can have a compounding effect. “For many individuals, major disaster like a hurricane, earthquake or wildfire is one of the worst situations in their lives,” explains Mendez. “They’re going through a lot of stress. To be discriminated against, that’s going to further do harm.”
Most trans people also must consider medication management during climate events. “When it comes to any one of these disasters or issues, it is definitely a huge, interrupted access to medications—insulin, HIV medication, hormone replacement, mental health medication,” McKenzie says.
There are existing structures in place to help people with medication refills during emergencies, says Alex Dworak, a family care physician in Omaha, Nebraska. Dworak regularly treats trans people in his daily practice and was a physician who treated Hurricane Katrina refugees in Omaha in 2005. “Even if you get shipped out to a camp, you should be able to go to a pharmacy and explain what you need,” he says.
But provider bias does exist. “The correct number of discriminatory medical professionals is zero, but we’re not at the correct number yet,” Dworak says. This bias is worsened by laws like South Carolina’s Medical Ethics and Diversity Act, which allows providers, healthcare institutions, medical practitioners and health insurers to deny non-emergency care that violates their religious, moral or ethical beliefs.
For those who are forced to go without HRT for any reason, climate disaster or not, Dworak says that missing several weeks or months of HRT is safe, “from a physiological perspective, in terms of bones, muscles or skin” even if your testes or ovaries have been removed. “From a psychological perspective,” he emphasizes that missing it is “urgent and even emergency, depending on somebody’s level of dysphoria.”
Dworak cautions that some climate disasters require special attention to medication management, especially with extreme heat, since many medications can exacerbate dehydration. Most notably, spironolactone, a medication many transfeminine people use to suppress testosterone levels, is a diuretic, meaning that users are at an increased risk for dehydration. Many other medications, like diuretics taken for liver and heart conditions, can also impact hydration.
Transmasculine people taking testosterone who also have sleep apnea or are smokers are at an increased risk of polycythemia: having too many red blood cells. Dehydration can also worsen polycythemia, so hydration is also important in that scenario. Dworak recommends hydrating from water and low-sugar electrolyte drinks, along with avoiding the direct sun during the hottest hours of the day during heat waves.
HRT storage requires pre-planning when facing extreme heat and cold too. Both feminizing and masculinizing HRT are largely heat resistant, so medication will do okay in heat waves, but injectable estradiol valerate is sensitive to light, so that is a consideration for any sudden travel. HRT in carrier oils may be affected by the cold; if your power is out, carrying the vial in your pocket should keep it safe.
McKenzie says that there is a knowledge gap in the trans community, especially within the Black trans community, about climate readiness. So, since Hurricane Ian, she has built up her organizations’ resources, and has launched the HRT Hub (short for Hurricane Response Team). The name is meant to grab attention by mirroring “hormone replacement therapy,” and the program trains other trans folks about climate justice and hurricane preparedness. “It’s a growing process,” she says. Their first cohort launched this month, alongside a command centre that will distribute aid.
The HRT Hub demonstrates that where systems fail, the LGBTQ2S+ community steps up. After Hurricane Helene, this was exemplified by the drag queens and DJs of North Carolina who distributed US $10,000 worth of supplies to their community before the National Guard made it in. In addition to being a researcher, Rothrock works with the organization OUT for Sustainability to create resources to improve climate resilience in the queer community. “We give them resources to make sure that they feel safer during these sorts of extreme weather events,” Rothrock says, citing a fridge magnet with an easy-access list of business and emergency response groups they made for the LGBTQ2S+ community in Ohio.
LGBTQ2S+ centres especially are stepping up, says Mendez, who has forthcoming research on the topic. “They’re filling in that role … where the government [is] intentionally ignoring this community.”
