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Transgender Mental Health

Written by Dr. Ramon Martinez III, Dr. Sarah Anderson
Published on May 3, 2023
Research Highlights

Over half a percent of people in the U.S. identify as transgender.

Transgender individuals are at higher risk for discrimination and suicide.

Access to gender-affirming treatments can improve mental health outcomes, including gender dysphoria.

Transgender people face stigmas affecting their mental health.

One in every 256 people are estimated to be transgender; one in twenty young adults report being transgender or nonbinary (identifying with neither gender; Pew 2022).

Transgender population estimates rely on self-reporting, which can be influenced by perceptions of community discrimination against lesbian/gay/bisexual/transgender/queer individuals (Meerwijk 2017; Coffman 2013).

  • Higher percentages of young adults reporting being transgender may be a result of perceived increases in visibility and social acceptance (UCLA 2022; Meerwijk 2017).

In a five-year follow-up study of youth who socially transitioned their gender (regardless of access to gender-affirming care; Olson 2022):

  • 94% remained transgender
  • 3.5% had transitioned to nonbinary

The American Psychiatric Association (DSM-5) and the World Health Organization (ICD-11) do not consider being transgender to be a mental illness/disorder.

  • Psychological distress resulting from a mismatch between gender identity and biological sex ('gender dysphoria') can be clinically significant and require care (APA 2022, APA 2013).

The WHO outlines the specific health needs and access to care for transgender individuals, including gender-affirming hormone therapy and surgery (WHO 2022).

Transgender youth who get gender-affirming care report 15% less suicidal ideation than those who want gender-affirming care but cannot access it (Turban 2019).

  • Parents and up to 93% of transgender youth self-report worry and stress at losing access to gender-affirming care (UCLA 2023).

 

For more information on gender-affirming hormone therapies, please read our Science Note: Transgender Hormone Therapy.

 

Transgender people are at high risk for discrimination & suicide.

Roughly half of transgender individuals report at least one mental health diagnosis, most com-monly major depression and anxiety (Wanta 2019). Transgender individuals have an increased risk for suicide due to stress from hiding their gender identities, violence from others, community exclusion, and family discrimination, rejection, or abuse (Bauer 2015; Austin 2020; Figure 1).

Figure 1. Transgender individuals face discrimination at school, work and in public. Bars indicate the percentage of transgender individuals (of 7,500 surveyed) who self-report facing stigma and discrimination in these scenarios over the last year. (CDC 2022).

 

A survey of 372 transgender youth found more than half had reported past suicide attempts and 86% had considered suicide (Austin 2020).

In a study of more than 400 transgender people, roughly 20% delayed routine health care for fear of discrimination (Seelman 2017).

In another study, transgender people of color (i.e. African American) reported higher rates of discrimination and depression (25% vs. 16%) than White transgender people (Jefferson 2014).

Transgender youth are at a 25-45% increased risk of using substances like cigarettes, alcohol, marijuana, cocaine, and prescription opioids to cope with psychological stress (Barbee 2022).

 

Read our Science Notes on Suicide Education & Prevention Programs and Suicide Risks in Veterans for more on policy approaches to reduce suicide in other vulnerable populations.

 

Gender-affirming drugs can improve mental health outcomes among transgender people.

Research suggests that gender-affirming care can improve mental health and quality of life (van Leerdam 2023; Baker 2021; Hughto 2016).

Transgender patients on puberty blockers report experiencing greater body satisfaction and decreased anxiety, depression, self-harm, and suicidal thoughts (Ramos 2021).

Hormone replacement therapy (HRT) improved quality of life and psychological wellbeing (van Leerdam 2023; Baker 2021; Hughto 2016).

While studies show that transgender people on HRT are still at higher risk of suicide compared to the general population, no large-scale review measures suicide risk among transgender people before and after HRT (Marshall 2015).

  • Factors that are protective against suicide among transgender people include self-esteem and voluntary emotional, social, and practical support (Kia 2021; Johns 2018).

 

MOST Policy Initiative is a 501(c)3 nonprofit organization that provides nonpartisan research information to members of the Missouri General Assembly upon request. This Science Note is intended for informational purposes and does not indicate support or opposition to a particular bill or policy approach. Please contact ramon@mostpolicyinitiative.org with any questions.

 

References

American Psychiatric Association. (2013). (rep.). Gender Dysphoria. Retrieved 2023, from https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf.  

Austin, A., Craig, S. L., D’Souza, S., & McInroy, L. B. (2020). Suicidality among transgender youth: Elucidating the role of Interpersonal Risk Factors. Journal of Interpersonal Violence, 37(5-6). https://doi.org/10.1177/0886260520915554  

Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021). Hormone therapy, mental health, and quality of life among transgender people: A systematic review. Journal of the Endocrine Society, 5(4). https://doi.org/10.1210/jendso/bvab011  

Barbee, H., Deal, C., & Gonzales, G. (2022). Anti-transgender legislation—a public health concern for transgender youth. JAMA Pediatrics, 176(2), 125. https://doi.org/10.1001/jamapediatrics.2021.4483  

Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in Ontario, Canada. BMC Public Health, 15(1). https://doi.org/10.1186/s12889-015-1867-2  

Brown, A. (2022). (rep.). About 5% of young adults in the U.S. say their gender is different from their sex assigned at birth. Pew Research Center. Retrieved 2023, from https://www.pewresearch.org/short-reads/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/.  

Centers for Disease Control and Prevention. (2022). (rep.). Patient-Centered Care for Transgender People: Recommended Practices for Health Care Settings. Retrieved 2023, from https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/affirmative-care.html.  

Coffman, K., Coffman, L., & Ericson, K. M. (2013). The size of the LGBT population and the magnitude of anti-gay sentiment are substantially underestimated. https://doi.org/10.3386/w19508  

Herman, J. L., & Flores, A. R. (2022). (rep.). How Many Adults and Youth Identify as Transgender in the United States? UCLA School of Law - Williams Institute. Retrieved 2023, from https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/?_sm_au_=iVV5Zj8QFq5k5M06.  

Jefferson, K., B. Neilands, T., & Sevelius, J. (2013). Transgender women of color: Discrimination and depression symptoms. Ethnicity and Inequalities in Health and Social Care, 6(4), 121–136. https://doi.org/10.1108/eihsc-08-2013-0013  

Johns, M. M., Beltran, O., Armstrong, H. L., Jayne, P. E., & Barrios, L. C. (2018). Protective factors among transgender and gender variant youth: A systematic review by socioecological level. The Journal of Primary Prevention, 39(3), 263–301. https://doi.org/10.1007/s10935-018-0508-9  

Kia, H., MacKinnon, K. R., Abramovich, A., & Bonato, S. (2021). Peer support as a protective factor against suicide in trans populations: A scoping review. Social Science & Medicine, 279, 114026. https://doi.org/10.1016/j.socscimed.2021.114026  

Marshall, E., Claes, L., Bouman, W. P., Witcomb, G. L., & Arcelus, J. (2015). Non-suicidal self-injury and suicidality in Trans people: A systematic review of the literature. International Review of Psychiatry, 28(1), 58–69. https://doi.org/10.3109/09540261.2015.1073143  

Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender population size in the United States: A meta-regression of population-based probability samples. American Journal of Public Health, 107(2). https://doi.org/10.2105/ajph.2016.303578  

Olson, K. R., Durwood, L., Horton, R., Gallagher, N. M., & Devor, A. (2022). Gender identity 5 years after Social Transition. Pediatrics, 150(2). https://doi.org/10.1542/peds.2021-056082  

Ramos, G. G., Mengai, A. C., Daltro, C. A., Cutrim, P. T., Zlotnik, E., & Beck, A. P. (2020). Systematic review: Puberty suppression with gnrh analogues in adolescents with gender incongruity. Journal of Endocrinological Investigation, 44(6), 1151–1158. https://doi.org/10.1007/s40618-020-01449-5  

Redfield, E., Conron, K. J., Tentindo, W., & Browning, E. (2023). (rep.). Prohibiting Gender-Affirming Medical Care for Youth. UCLA School of Law - Williams Institute. Retrieved 2023, from https://williamsinstitute.law.ucla.edu/publications/bans-trans-youth-health-care/.  

Seelman, K. L., Colón-Diaz, M. J. P., LeCroix, R. H., Xavier-Brier, M., & Kattari, L. (2017). Transgender noninclusive healthcare and delaying care because of fear: Connections to General Health and mental health among transgender adults. Transgender Health, 2(1), 17–28. https://doi.org/10.1089/trgh.2016.0024  

Turban, J. (2022). (rep.). What is Gender Dysphoria? American Psychiatric Association. Retrieved 2023, from https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.  

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2). https://doi.org/10.1542/peds.2019-1725  

van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The effect of gender-affirming hormones on gender dysphoria, quality of life, and psychological functioning in transgender individuals: A systematic review. Transgender Health, 8(1), 6–21. https://doi.org/10.1089/trgh.2020.0094  

Wanta, J. W., Niforatos, J. D., Durbak, E., Viguera, A., & Altinay, M. (2019). Mental health diagnoses among transgender patients in the clinical setting: An All-Payer Electronic Health Record Study. Transgender Health, 4(1), 313–315. https://doi.org/10.1089/trgh.2019.0029  

White Hughto, J. M., & Reisner, S. L. (2016). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health, 1(1), 21–31. https://doi.org/10.1089/trgh.2015.0008  

World Health Organization. (2023). (rep.). Gender incongruence and transgender health in the ICD. Retrieved 2023, from https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd

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