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LORNA BENSON: Lesbian, gay, bisexual, transgender, and queer people are becoming more socially accepted in Minnesota, particularly since the state legalized same sex marriage. But some say they still have a long way to go to overcome prejudice, discrimination, and other social hurdles.

Aurora Adams came out as a woman last year. Her path to this pivotal moment has been a complicated, lonely journey, marked by years of depression and anxiety that continue to take a toll on her mental health.

Born male, Adams says she can hardly remember a time when she didn't feel ostracized for expressing interests that others viewed as more feminine. School was a source of constant stress.

AURORA ADAMS: I'd get locked out of classroom doors. I'd be shoved into the girls' locker room. I'd be told by people that I should kill myself. I mean, that just happened again and again, and again, and again.

LORNA BENSON: Today, at age 27, Adams is still trying to find acceptance and regain her health.

AURORA ADAMS: This is my room, and this is where I'm living for three months.

LORNA BENSON: There's not much to see in Adam's temporary room beyond the bed in the corner, her television, a dresser, and a couple of chairs. She has been living in supervised housing in Maplewood since March after seeking help from an emergency room for her suicidal thoughts. It was her third hospitalization.

Last July, she attempted to kill herself by mixing prescription medications and alcohol. A few months earlier, she entered a hospital after deliberately harming herself by cutting and burning her skin.

Adams doesn't blame her suicide attempt or thoughts on her struggles over gender identity, what researchers describe as a person's inner sense of their own gender. But she acknowledges that it is a factor in how people treat her.

At the time she attempted suicide, Adams was unemployed and worried that she might soon be homeless. She had just walked away from her job at a cable company call center without giving notice. She says it was stressful work that was especially hard to manage as she began to assert her true self.

AURORA ADAMS: Every single day I'd be on the phone, and as you can tell probably by my voice, people might gender me masculine on the phone. And that hurts, especially when you tell the customer or the person you're speaking with, I'm actually a woman, so please gender me female, and they don't.

LORNA BENSON: In the weeks before Adams left her job, after she told people she considered herself a woman, many of her colleagues were supportive. But she says plenty of others had no regard for her privacy.

AURORA ADAMS: Asking, Have you had the surgery yet? is very not OK in such a setting, and it's too high of a number for the amount of times I was asked that at my job. I mean, I very quickly started eating alone or going into the restroom stall and crying. The amount of stress and anxiety that comes with it is astronomical.

LORNA BENSON: While more research is needed, the limited data that are available suggests that suicide attempts are pervasive among transgender people. A 2011 national survey of more than 6,400 transgender people found that a staggering 41% had tried to take their lives at some point.

But comparing the survey suicide attempt rate to other populations is not possible because few mainstream studies have included questions about sexual orientation or gender identity. The data are so lacking that there are no good estimates of how many people identify as lesbian, gay, bisexual, transgender, or queer in the US.

EDWARD EHLINGER: We're a very heterosexist society. We really think in terms of male-female gender identity, male-female.

LORNA BENSON: Ed Ehlinger is Commissioner of the Minnesota Department of Health. He says the lack of data has made it difficult for public health officials to determine to what extent members of the LGBTQ community have poorer health than the general population.

For example, does the population have higher rates of chronic diseases related to the stress they experience in their daily lives? Do they have more cancers due to their higher smoking rates?

How different are health experiences within the population, which includes a very diverse group of people? The information is scant. But Ehlinger says asking more detailed questions about gender and sexual orientation isn't as simple as it sounds.

EDWARD EHLINGER: We need to have agreement on what were asking. We have to agreement on what the definition of those terms are, and then we have to be able to share that information from one electronic system to another.

LORNA BENSON: That effort, he says, will likely take years, but there is some momentum. In a 2011 report, the Institute of Medicine recommended collecting sexual orientation and gender identity data in government health surveys, federally-funded research and electronic medical records. Some research conducted in Minnesota already collects that data.

The College Student Health Survey asks tens of thousands of students at 40 post-secondary schools about their sexual orientation and gender identity, but the population of transgender students who've participated in the randomized survey has been too small to analyze.

The Minnesota Student Survey, conducted every three years in the state's public schools, added a sexual orientation question in 2013, but the survey does not request information about gender identity.

LGBTQ advocates are aware of the data collection challenges, but they're not letting that hinder their campaign to be properly counted. They've forged ahead with their own data gathering efforts where they can.

DYLAN FLUNKER: How are you? Are you interested in taking a survey for me? You can win a Mr. or a frisbee. Cool. Let me grab you one.

LORNA BENSON: In Minnesota, some of what is known about health disparities in the LGBTQ population comes from a relatively new survey conducted at the Twin Cities Pride Festival.

This is the third year that the Rainbow Health Initiative, a Minneapolis based advocacy group, has conducted its Voices of Health Survey. Dylan Flunker, who is transgender, is a policy and community organizing coordinator with the group.

DYLAN FLUNKER: Even if the state does start asking questions about sexual orientation and gender identity on all of their health surveys, it still won't give the depth of information that we're able to collect in our sample, simply because the percentage of the population that's LGBTQ is small.

LORNA BENSON: The findings from the Voices of Health Surveys appear to be consistent with similar surveys conducted elsewhere in the country that have revealed some potentially alarming health concerns for LGBTQ people.

John Salisbury, Rainbow Health Initiative's Director of Programs, says sexual and gender minorities experience several high-risk behaviors and health problems at twice the rate of the general population.

JOHN SALISBURY: We find higher rates of smoking, we find higher rates of alcohol consumption, higher rates of anxiety, depression, and PTSD in our survey. And we think that's due to lifetime experiences with discrimination, especially a lot of it in health care settings.

LORNA BENSON: Salisbury says discrimination in health care or even the fear of it, can cause people to reduce or delay the care they need. In the Voices of Health Survey, a quarter of the respondents reported receiving poor quality care because of their sexual orientation or gender identity.

1 in 6 survey participants said they had been discriminated against by their health care provider. Among transgender respondents in particular, nearly 1 in 2 said they had been discriminated against by a health care provider.

Alex Iantaffi, an assistant professor in the University of Minnesota's Program in Human Sexuality, is not surprised by the results.

ALEX IANTAFFI: I've heard health professionals not just mispronounce, but kind of say things like, he, she, or whatever they are.

LORNA BENSON: Iantaffi is a researcher and a marriage and family therapist. When Iantaffi, who is transgender, was looking for a specialist to perform part of his gender transition surgery a few years ago, he met with an experienced surgeon. He recalls having a great conversation with the physician until it was time to schedule his procedure.

ALEX IANTAFFI: And then turned around to me and said, but I don't operate on transgender people, so you'll have to go to those other surgeons.

LORNA BENSON: Iantaffi says he was stunned at how comfortable the doctor was with his decision to not treat a particular group of people. He suspects the physician didn't feel knowledgeable about transgender patients. But Iantaffi says that's not a good enough reason to deny care.

ALEX IANTAFFI: To me, that really illustrates how people don't understand sometimes how simple it can be to experience that discrimination.

LORNA BENSON: While advocates and researchers alike agree that there's a great need for more data on the health challenges LGBTQ people face, Iantaffi says highlighting the results of new research could be a double-edged sword. He says, it's possible that some people won't want to associate themselves with a community that may have substantial health risks.

Still, he says, if increased public awareness of health disparities inspires more compassion for sexual and gender minorities, it could make it easier for them to improve their health. Lorna Benson, Minnesota Public Radio News.