Gender & Mental Health: Identity, Oppression, Treatment
Reviewed by therapist.com Team
Gender is the way we choose to express our identity on a spectrum of masculinity, femininity, and androgyny.
In the United States, gender is often assigned at birth to match an infant’s sex assignment. This assignment relies on external attributes, such as genitalia, and external sources of judgment, such as hospital staff.
However, because gender is an expression of internal truth, only an individual has the right to determine their gender identity. Because of this, a person’s gender may change over time, or it may stay the same.
Historically, certain views of gender, especially in Western cultures, were based on the gender binary. The gender binary limits gender expression to two options—man and woman—and perpetuates the idea that they are inherent opposites.
Today’s understanding of gender is not a binary of opposite choices, but includes a wide variety of identities. A person may identify as a man or a woman, but those are not their only options, and those identities (as well as all others) are chosen based on internal discernment, not external judgment. Some gender identities include:
- Cisgender: A person’s whose gender identity matches their assigned sex at birth.
- Transgender: A person whose gender identity does not match their assigned sex at birth.
- Nonbinary/genderqueer/gender nonconforming: A person who does not subscribe to the male-female binary. Individuals who are nonbinary may identify with elements of both masculinity and femininity, with neither masculinity or femininity, or feel as if their gender identity exists outside of any standard conception of gender.
- Genderfluid: A person whose gender identity changes and is not fixed on a single gender identity.
- Queer: An umbrella term used by people who are not cisgender or heterosexual to describe themselves and the LGBTQIA+ community. Although the term has traditionally had a negative connotation to it, many LGBTQIA+ individuals have reclaimed this word to describe themselves. Because of its potential for offense, though, it should only be used by individuals who use the term to self-identity or to describe others who self-identity as queer.
Gender is about how you identify and express yourself. Although sex and sexuality are related concepts, they are different terms referring to different things.
Sex is a category based on your biological, physical, hormonal, and genetic attributes. Most people are assigned male, female, or intersex at birth, based on their external sex organs. However, your sex is also informed by your chromosomes, hormones, internal sex organs, and secondary sex characteristics. Because most of these other factors are not considered during sex assignment at birth, it’s important to note that sex, like gender, is a social construct.
Sexuality refers to your sexual feelings and behaviors. You do not need to have had sex to know what your sexuality is, although your sexual experiences may inform your sexual identity. Common sexualities include gay, lesbian, heterosexual, asexual, bisexual, and pansexual.
Your sex, gender, and sexuality are part of your identity, but it’s important to note that they are all different parts. They can inform one another, but they don’t have to.
For example, a person may have been assigned female at birth, come out as a transgender man, and have a girlfriend, but still identify as gay, even though that person may be perceived as being in a male-female relationship. Similarly, a person who was born intersex but raised as a woman, identifies as a woman, and has a boyfriend may consider herself both cisgender and straight.
How your gender affects your mental health is highly dependent on how society reacts to your gender. Unfortunately, gender oppression has been a reality throughout history in multiple cultures. It’s important to note that experiencing oppression is what increases a person’s risk for mental illness, not identifying with a specific gender. Common forms of gender oppression include:
- Sexism: Sexism occurs when a person is oppressed due to their sex or gender. Historically, women and feminine-presenting people have been the main targets of sexism.
- Patriarchy: Patriarchy occurs when a system or culture elevates masculinity as a superior gender expression. Cisgender men in particular benefit from patriarchal societies. Patriarchy is inherently sexist toward women and other genders that celebrate or even just display their femininity, androgyny, or rejection of the gender binary.
- Transphobia: Transphobia targets people who identify as a gender other than the one they were assigned at birth or who identify as a gender outside of the gender binary.
It’s important to note that gender oppression does not exist in a vacuum. People may face discrimination or oppression for a number of reasons in addition to their gender, such as:
A person’s gender identity may intersect with one or more of the above factors to exacerbate or temper the effects of discrimination or oppression. For example, identifying as a woman in the workplace may result in discrimination in the form of lower income or fewer opportunities. Such a situation may become more or less complicated depending on the woman’s age, pregnancy or parenthood status, or other factors.
Sexism has a marked effect on women’s mental health as well as their ability to access mental health treatment. Because of sexism and patriarchy, women have to navigate barriers and disparities like:
- Poverty: Women are more likely to live in poverty than men because of gender pay disparities, unpaid or undervalued domestic work and care work, job insecurity, and a lack of legal rights and social protections to engage in work.
- Lack of education: Girls who are denied education due to their gender are more susceptible to traumas like child marriage, poverty, domestic violence, and increased maternal and child mortality.
- Healthcare discrimination: The medical industry tends to favor male symptoms over female symptoms for diagnosis methodology, underfund research for diseases predominantly affecting women, dismiss female pain or self-reported symptoms as overblown or hysterical, and exclude or underrepresent female participants in clinical trials. This leads to more women who are faced with misdiagnosis, delayed diagnosis, ineffective treatments, dangerous side effects, or a complete lack of diagnosis or treatment.
- Gender roles: Gender roles are sexist stereotypes that prescribe certain duties and characteristics to people based on the gender binary. Female gender roles often force women into caregiving roles, ban them from leadership positions, pressure them into marriage and motherhood, cast them as overly emotional and inherently nurturing, and encourage them to submit to male authority, no matter how violent. Studies indicate that gender roles often result in negative physical and mental health outcomes for women and men.
- Objectification: Women in the United States face a culture of objectification that prescribes value to women based on their sexual desirability. This culture promotes often unattainable beauty standards and increases girls’ and women’s risk for eating disorders, anxiety, depression, and other mental illnesses.
- Pregnancy & parenthood: Pregnancy, miscarriage, infertility, motherhood, and related experiences can create a minefield of mental health issues for women.
- Workplace sexism: Working women in the United States face a gender pay gap, zero days of guaranteed paid maternity leave, no representation or under-representation in management, and significant sexual harassment in the workplace.
- Violence against women: Nearly one in three women in the world have experienced intimate partner violence, non-partner sexual violence, or both, according to the United Nations. At least one in five women have experienced attempted rape or rape, according to the World Helath Organization (WHO). Such violence and trauma increases a woman’s risk for depression, anxiety, sexually transmitted infections and diseases, unplanned pregnancy, and other negative physical and mental health outcomes.
- Increased risk of mental illness: Studies show that anxiety disorders and depression are both twice as likely in women than men. Women’s greater risk of experiencing sexual violence also increases their risk for developing post-traumatic stress disorder (PTSD).
Sexism and patriarchy often contribute to women’s negative physical and mental health outcomes. If you are a woman suffering from mental illness or dealing with trauma after experiencing abuse, assault, or other forms of violence or gender oppression, you are not alone. Click here to find a therapist near you. If you are in crisis, call, text, or chat with one of the following hotlines for immediate assistance:
Patriarchy, rigid gender roles, and toxic masculinity can also have negative physical and mental health outcomes for men. Studies show that countries that invest in gender equality improve outcomes for both men and women.
Male gender stereotypes force men to repress their emotions under the guise of “strength” and discourage men from seeking help, especially for mental health problems. As a result, men face higher rates of substance abuse than women. Men are also nearly four times as likely to die by suicide and are more likely to choose more violent methods, such as use of firearms.
Rigid definitions of masculinity are correlated with negative health outcomes for men. If you are a man struggling with mental illness, you are not alone. Click here to find a therapist near you. If you are in crisis, call, text, or chat with one of the following hotlines for immediate assistance:
- National Suicide Prevention Hotline: 1-800-273-TALK (8255)
- SAMHSA’s National Helpline: 1-800-662-HELP (4357)
- Crisis Text Line: Text HOME to 741741
No. Identifying as transgender, nonbinary, genderqueer, gender nonconforming, or any other gender identity does not mean that an individual is struggling with mental illness. Rather, it is the discrimination and oppression that transgender individuals face, particularly transphobia, that puts them at greater risk for certain mental health disorders.
Gender dysphoria is a mental health disorder experienced by some, but not all, transgender individuals. It is characterized by psychological distress focused on a strong desire to identify as a gender other than the gender a person was assigned at birth.
The psychological stress is what is key here, not the desire to identify as another gender. Gender dysphoria may be alleviated by pursuing affirmation of your gender identity by:
- Coming out to your friends, family, and community
- Changing your name socially and/or legally
- Changing your gender expression via hair, clothes, makeup, etc.
- Pursuing physical changes to your body through medication and/or gender-affirming surgery
Research shows that psychological distress often experienced by transgender individuals is correlated with experiences of social rejection, stigma, discrimination, oppression, and violence.
Trans people are also more likely to live through traumatic experiences like poverty, unemployment, and homelessness. Nearly 30% of trans adults live in poverty. The unemployment rate for trans people is twice that of the general population and is even higher for trans people of color. One in five transgender people has experienced homelessness.
Suicide attempts in particular are higher among transgender and nonbinary teenagers than cisgender teens. One study by the American Academy of Pediatrics (AAP) found that 50% of transgender male teens, 42% of nonbinary teens, and 30% of transgender female teens had attempted suicide at least once, compared to just 18% and 10% of cisgender female and male teens, respectively.
People who identify as transgender also face discrimination when seeking healthcare. In 2012, a survey by the Human Rights Campaign (HRC) found that only about one-third of surveyed companies (and about one-fifth of Fortune 500 companies) provided equitable healthcare coverage for transgender workers.
Gender-affirming surgery is expensive and unaffordable for many trans people. Estimates put the average cost of gender-affirming surgery anywhere from $5,000 to $50,000. Research has suggested that gender-affirming surgery may decrease rates of anxiety and depression for trans individuals. It is important to note, however, that an individual may fully identify as trans without pursuing gender-affirming surgery or other medical interventions, such as hormone therapies.
If you identify as transgender, nonbinary, gendernonconforming, or genderqueer, are struggling with or questioning your gender identity, or need gender dysphoria treatment, you are not alone. Help is available now. Click here to find a gender-affirming therapist near you. If you are in crisis, call, text, or chat with one of the following hotlines for immediate assistance:
- TrevorLifeline: 1-866-488-7386
- TrevorText:Text START to 678-678
- National Suicide Prevention Hotline: 1-800-273-TALK (8255)
- Crisis Text Line: Text HOME to 741741
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