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Transgender people and mental health

Reviewed by Susan Radzilowski, MSW, LMSW, ACSW

A transgender woman leans on a railing and looks into the distance

When you’re transgender (or “trans”), your gender identity or expression differs from your birth-assigned sex. In the United States, around 1.6 million people age 13 and up identify as transgender, and nearly one in five trans people are between ages 13 and 17.1

Gender identity vs. gender expression

Your gender identity is your own internal, deeply held knowledge of your own gender.2 Everyone has a gender identity, and other people can’t determine it just by looking at you.

Your gender expression is the way you show your gender to the world. This can include your clothing and hair, the way you speak and act, and your name and pronouns.

Transgender, cisgender, nonbinary, and gender nonconforming

These four types of gender identities sometimes overlap, but they have different meanings.

When you’re transgender, your gender identity doesn’t match the binary sex (male or female) you were assigned at birth. Transgender men and boys are men and boys who were designated female at birth. Transgender women and girls are women and girls who were designated male at birth. Gender is different from sexual orientation, which refers to a person’s romantic, emotional, and/or sexual attraction to others. Just like cisgender people, trans people can have any sexual orientation: straight, gay, lesbian, bisexual, queer, asexual, pansexual, and so on.

If your gender identity matches the binary sex on your birth certificate, you’re considered cisgender (or cis).

Nonbinary people, who may use gender-neutral pronouns (they/them), have gender identities that don’t fit neatly inside either of the two binary options of “male” and “female.” The word “nonbinary” can include many different ways of expressing gender. Some nonbinary people call themselves transgender, and others don’t.

If you’re gender nonconforming, you identify in a way that doesn’t fit our culture’s masculine or feminine expectations. You can be gender nonconforming whether you’re cis, trans, or nonbinary. Note that being trans doesn’t necessarily make a person gender nonconforming—you may express your gender identity in a conventionally feminine or masculine way.

Transitioning

Transitioning is a series of social, legal, and/or medical steps you can take to bring your gender expression into alignment with your gender identity. It can include things like coming out to your loved ones and community, using a new name or new pronouns, dressing differently, starting to wear makeup or stopping, taking hormones, having gender-confirming surgery, or changing the gender markers on your birth certificate, driver’s license, and other documents.

Transitioning involves different steps for different people. It’s important to note that you don’t have to transition, medically or otherwise, to be trans. The only criterion is realizing that your gender identity differs from your sex assigned at birth.

While transitioning is an important part of many trans people’s journeys, not every trans person wants or is able to do it. Some people transition in only some aspects of their life, and some don’t at all. People may also avoid transitioning because they can’t afford it, gender-affirming care isn’t legal or available in their area, or their community isn’t safe.

Every trans person should be able to make their own decisions about how they present themselves, and all trans people deserve respectful care that affirms and honors who they are.

How does being transgender affect mental health?

Being transgender isn’t a mental health condition—it’s an identity. Just like cisgender people, trans people can enjoy excellent physical and mental health while being the gender they know themselves to be.

Research shows that trans people who are comfortable with and confident about their gender identity—including how they choose to express it—have higher self-esteem and better overall mental health than those who don’t.3

Mental health risks

Transgender and nonbinary people are often denied the rights, respect, safety, and considerations experienced by cisgender people. Transphobia (meaning prejudice against, stereotypes about, and scapegoating of trans people) affects a person’s health and safety. Many people are forced to deal with it in their families and communities, as well as in local and national politics, media and entertainment, religious institutions, and other contexts. Because trans people are so highly stigmatized, internalized transphobia can also pose mental health challenges.4

Research shows that the more social rejection, stigma, discrimination, and oppression a trans person faces, the more psychological distress they experience.5

Challenges to transgender people’s mental and physical health include:

  • Bullying and mistreatment: Young trans and nonbinary people are at a high risk of being bullied.5 On a larger stage, some political leaders use anti-trans rhetoric to target transgender and nonbinary adults and kids, promoting policies that suppress their rights (even though the majority of Americans across political parties are opposed to anti-trans laws).6
  • Violence and harassment: Trans people of all ages face an increased risk of harm from both strangers and people they know.7
  • Workplace discrimination and unemployment: At work, transgender people frequently experience harassment, physical abuse, sexual abuse, privacy violations, and problems getting hired in the first place.8 The unemployment rate for trans people is twice that of the general population, and even higher for trans people of color.9
  • Poverty: Nearly 30% of transgender adults live below the federal poverty threshold.10
  • Housing instability: One in five trans people has experienced homelessness.11
  • Health care disparities: Positive, respectful, competent health care can be hard to come by for trans people.12 There aren’t enough providers trained to treat trans and nonbinary patients, so they face discrimination and mistreatment in many care settings.
  • Unaffordable gender-confirming care: In addition to the ongoing cost of hormone treatment, estimates put the average price of gender-confirming surgery at $5,000 to $50,000.13
  • Pressure to “become” cisgender. Gender identity conversion efforts—attempts to force a trans child or adult to be cis—are, in addition to being unethical, linked to severe negative mental health outcomes.14

The stress and trauma of these interconnected circumstances can contribute to:

If you’re in crisis and need immediate help, contact one of the following hotlines for assistance: 

Gender incongruence and gender dysphoria

Gender incongruence—the strong, persistent awareness that your gender identity doesn’t correspond to your assigned sex—can start in childhood, adolescence, or adulthood, and it often inspires transitioning.15 The World Health Organization describes gender incongruence in its health guidelines, the ICD-11, which the US may adopt as soon as 2025.

US health care professionals often use the clinical diagnosis of gender dysphoria, a similar term that emphasizes the distress or unease a mismatch between your gender identity and assigned sex can cause. Many providers require patients to get a gender dysphoria diagnosis to access certain medical steps of a transition.

Experts point out that not all trans people experience gender dysphoria, and not all people with gender dysphoria identify as transgender. In addition, having to get a separate gender dysphoria diagnosis to access your necessary identity-related health care can be burdensome if you don’t have access to high-quality, respectful health care treatment.

How gender-affirming care helps

A growing body of research has shown that gender-affirming care—which can include gender-affirming therapy, hormones, and surgery—significantly improves trans people’s overall well-being and reduces the risk of depression and suicidality in both the short and the long term.16, 17

Gender-affirming therapy helps you explore and understand your gender identity, access support, learn to cope with challenges, and assess transitioning options. Therapy can also help you make decisions around coming out to family, peers, and others (such as teachers).

Couples therapy or family therapy can help loved ones understand your experiences, improve communication, and potentially help family members or partners adjust as you transition.

Speech therapy can help you learn to speak comfortably in a way that suits your gender identity, addressing your vocal pitch, volume, and inflection.

Masculinizing or feminizing hormone therapy produces physical changes that can help align your body with your gender identity. For trans youth, research suggests that temporarily suppressing early puberty reduces gender dysphoria in a safe, effective way.18

Gender-affirming surgery—procedures to enhance or remove breasts, feminize or masculinize facial features, alter the voice, or reconstruct genitals—can help bring your appearance and voice into line with your gender identity.

Resources for transgender people and their families

If you’re transgender or nonbinary and would like support, resources are available. Here are a few to check out:

  • TransMission offers small scholarships to help offset costs related to therapy, hormones, gender-affirming clothing, living expenses, and more.
  • Trans Families provides support and resources for transgender people and their families.
  • Gender Spectrum offers education, training, and support to families, transgender youth, educators, and health care professionals.
  • PFLAG National has dozens of local chapters that provide support and resources for LGBTQ+ people and their families, including transgender people and their loved ones.
  • Trans Lifeline is a transgender-led organization that offers crisis intervention and suicide prevention services to trans people in the US and Canada.

For more, visit GLAAD’s transgender resources page.19

Find gender-affirming therapy

If you or a loved one are looking for support around gender identity, help is available. Search our directory to find a gender-affirming therapist near you.

How to be an ally

It’s important for cis people to show up for trans and nonbinary people in supportive and informed ways, like these:

Use language affirmed by the person. The terms we’re using in this article aren’t the only ones trans people use to describe themselves. Respect and use whichever terms the person has affirmed.

Don’t judge people by how they look or act. There’s no “right” way to be trans, and someone’s gender identity can’t always be determined by how they behave, dress, speak, or look.

Avoid assuming a person’s gender identity is public knowledge. Unless someone gives you permission to share their gender identity with others, help them maintain their privacy until they’re ready to share it.

Ask what pronouns people use, and feel free to share yours. If you’re unsure which pronouns to use when referring to someone, it’s okay to ask. When you introduce yourself, sharing your own pronouns can open the door for others.

Increase your awareness of gender and transgender stereotypes. Pay attention to how you comment on, compliment, or share opinions about other people’s appearance, behavior, or life choices. It’s easier than you think to inadvertently reinforce the idea that there are only two genders—or the idea that trans people, nonbinary people, women, or men have to look or act a certain way.

Advocate for supportive and inclusive policies in schools, religious institutions, health care, businesses, and other contexts. There are many ways to support trans people’s rights and safety. You can vote; start or join a letter-writing campaign to elected reps, school boards, health care providers, or religious leaders; and ask businesses and institutions to adopt trans-inclusive nondiscrimination policies.

Challenge any transphobic comments or behavior you witness. It can be intimidating in the moment to speak up against anti-trans jokes, statements, or assumptions, but it has a positive ripple effect. Each time you do it, you may help trans people feel supported, you may help other allies feel more confident speaking out, and you may help someone realize they’re hurting others and can do better.

To learn more about offering support, download the National Center for Trans Equality’s guide to being a good ally.20

Sources

About the author

The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

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