Transgender Anxiety: A Public Health Issue In Transgender Youth & Adult Mental Health

“Transgender” or “trans” are terms used to describe an individual whose gender identity differs from the one they were assigned at birth. Though many identify as trans men or trans women, transgender individuals may also identify as non-binary or use other terms to describe themselves, like multi-gendered or third gender. Although reports vary, the Human Rights Campaign (HRC) estimates more than two million people from all walks of life identify as trans in the US. 

Here, we’ll explore the state of mental health for transgender youth and adults in the US today and the factors that contribute to mental health challenges among this population. We’ll then offer suggestions for ways that individuals and communities can support trans mental health.

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The prevalence of mental health conditions among transgender individuals

Studies repeatedly indicate that mental health concerns like anxiety, depression, and self-harm disproportionately affect trans people compared to their cisgender counterparts. Again, rather than mental health challenges being inherent to any LGBTQ+ identity, it’s typically the lived experiences of discrimination and marginalization that lead to mental health disparities among queer and trans individuals. 

Although gender-affirming mental health care can help address symptoms, anti-trans legislation, discrimination in healthcare settings, and other barriers to treatment exist for many gender-diverse people. Bills and laws restricting a person’s ability to receive gender-affirming hormones, surgical procedures, and mental health care and experience general equality under the law can contribute to or exacerbate mental health challenges.

Mental health among transgender youth specifically

Transgender and gender-diverse youth may be particularly vulnerable to mental health challenges due to their lived experiences of discrimination and exclusion. For example, the Trevor Project’s 2024 US National Survey on the Mental Health of LGBTQ+ Young People reports that:

• 46% of transgender and nonbinary youth seriously considered attempting suicide in the past year compared to 39% of LGBTQ+ youth overall, with queer youth of color at greater risk than white queer youth.
• Trans and non-binary youth who report attending gender-affirming schools are at a lower risk of suicide.
• 90% of queer youth report their mental health being negatively impacted by recent politics.
• Almost half of queer youth ages 13–17 report being bullied at school in the last year, which can contribute to an increased risk of suicide. 

About transgender anxiety 

While almost everyone will experience feelings of anxiety and nervousness from time to time, having a diagnosable anxiety disorder is different. An anxiety disorder involves persistent worry or fear that is difficult to control and negatively impacts daily functioning and overall well-being. There are many different types of anxiety disorders that a person could experience, from generalized anxiety disorder to panic disorder to specific phobias and others. 

Anxiety is a highly prevalent type of mental health condition among transgender and gender-diverse individuals. One 2025 review examined over 70 studies on the topic, including over 70,000 transgender participants from 23 countries, and it reveals that 43% currently live with anxiety. Non-binary individuals within this population experience even higher rates (59%) of anxiety compared to transmasculine and transfeminine individuals. Again, this high prevalence is likely due to lived experiences of rejection, discrimination, harassment, misgendering, and others that can contribute to a person feeling persistently anxious. 

Gender dysphoria and mental health

Gender dysphoria is when a person experiences distress or discomfort due to the mismatch between the gender they identify with and the one they were assigned at birth. It is not the same thing as being transgender, but many transgender people experience it. Experiences of gender dysphoria may be caused or exacerbated by systemic factors that make it difficult and even dangerous to live as one’s authentic self.

Studies suggest that transgender and nonbinary youths may be particularly at risk for mental health challenges—such as anxiety—influenced by experiences of gender dysphoria. As many as 86% of gender-diverse young people report suicidal ideation and 56% report a previous suicide attempt. It’s just one reason why providing affirming health services to transgender youth seeking care can be so important.

Gender expression and risk of transgender anxiety

The concept of gender is largely considered a social construct—meaning that the ideas and behaviors associated with being certain genders are shaped by society, culture, and social norms rather than being strictly determined by biology. 

While gender identity is internal, gender expression is how someone outwardly presents their gender through clothing, behavior, etc. When an individual’s gender identity or expression doesn’t align with societal expectations, they may face discrimination and alienation that contribute to experiences of gender dysphoria—which can contribute to anxiety and other challenges in turn.

Signs of gender dysphoria

There is debate within the scientific community over whether gender dysphoria should be classified as a mental health condition. On the one hand, a diagnosis may benefit trans people by providing a more direct link to gender-affirming care. On the other hand, some point out that labeling it as a condition might encourage further stigmatization of trans people as having a mental illness inherent to their identity—which, despite not being true, reflects a long history of harmful pathologization of queer identities in healthcare.

The most recent iteration of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) outlines the symptoms an individual with dysphoria may experience. While its presentation may vary between people, DSM-5-TR guidelines say an individual must experience at least two of the following signs for at least six months to qualify for a diagnosis:

• A significant incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics)
• A strong desire to separate from one's primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
• A strong desire for the primary and/or secondary sex characteristics of the other gender (or some alternative gender different from one’s assigned gender)
• A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
• A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
• A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

The effects of family rejection and lack of affirmation, especially for transgender youth

Some trans individuals are unsupported by their loved ones in their journey to gender affirmation and acceptance. This often stems from cultural beliefs, religious beliefs, and social pressures that are informed by discriminatory systems. 

Such rejection can contribute to significant psychological distress, including anxiety as well as depression and suicidal thoughts. Transgender youth who experience family rejection to the degree that they are forced to leave their home are also significantly more likely to experience homelessness and other serious challenges.

Positive outcomes for gender-diverse youth and adults with family acceptance and support 

Family acceptance and support are thought to be key for positive mental health outcomes among transgender individuals—particularly young people. Support from family can foster a sense of self-worth and confidence and significantly reduce the risk of suicidal ideation and attempts and other mental health challenges. 

Acceptance can also be the foundation for a strong social support system, which can help young people navigate challenges. Whereas parental rejection has been linked to mental health challenges in trans youth, studies suggest acceptance can be a protection against poor mental health outcomes and risky behaviors. 

Discrimination and marginalization faced by transgender people

Many transgender people experience daily discrimination and marginalization that present challenges in key areas of life. For example, studies suggest that transgender individuals are more likely to experience unemployment, underemployment, and discrimination in hiring and promotion. This can have a ripple effect on the individual's life and well-being when troubles with unemployment restrict their ability to find stable housing or affordable healthcare services, including gender-affirming care. 

Examples of other ways that discrimination can negatively impact trans lives include:

• Bullying, harassment, and rejection from family and friends can contribute to social isolation and adverse mental health outcomes.
• Transgender youth may experience discrimination within schools, leading to bullying, harassment, difficulty integrating, and educational interruption.
• Discrimination can extend to the legal system, where transgender individuals may face bias in court and difficulty receiving legal protections.
• Transgender individuals experience disproportionately high rates of violence, including physical assault, sexual assault, and hate crimes. 

Intersectionality and compounding vulnerabilities

This concept is about understanding how all of a person’s identities may intersect with their gender identity to influence mental health. For example, a Black trans woman might experience racism, sexism, and transphobia simultaneously, creating a unique set of challenges that differ from those that may be faced by a white trans woman or a Black cisgender woman. 

The role of gender-affirming care in addressing transgender anxiety

Gender-affirming care encompasses a range of medical, mental health, and social interventions where the provider is informed and affirming of a person's identity. One form of gender-affirming care is mental health care, where the provider uses the person's preferred name and pronouns and understands the historical and modern challenges that LGBTQ+ individuals tend to face in society. 

Gender-affirming care can also take the form of physical health care, whether it's routine medical care in an inclusive environment or specific types of care to physically affirm a person's gender, like hormone therapy or surgical interventions. Some transgender and gender-diverse individuals may choose to pursue gender-affirming medical interventions to better align their physical and social appearance with their gender identity, which can often help alleviate dysphoria and reduce associated anxiety. 

Even those who don't choose to medically transition still deserve health care from affirming and welcoming providers. Research emphasizes the importance of timely availability of gender-affirming care of all kinds, especially for youth, as delays can exacerbate mental health challenges. Lack of this type of care may contribute to increased anxiety and other challenges.  

Mental health benefits of gender-affirming medical interventions

Studies have indicated that gender-affirming care—particularly medical interventions like gender-affirming hormone therapy and surgery, for those who choose to pursue them—is often associated with decreased depression, anxiety, and suicidal ideation in transgender individuals. These benefits are typically observed within the first year of care. 

Gender-affirming care can improve self-esteem, confidence, and overall well-being. When individuals feel more aligned with their true gender identity, it can also lead to increased self-acceptance and a greater sense of belonging. Gender-affirming care can provide opportunities for social support and inclusion through peer groups and community resources as well, helping individuals feel less isolated and more connected. 

What you can do to support transgender mental health 

You can support transgender people by educating yourself through resources like The Trevor Project, Advocates for Trans Equality (A4TE), and the Gay, Lesbian & Straight Education Network (GLSEN). You might also:

• Familiarize yourself with LGBTQ+ terminology
• Use each person's preferred name and pronouns to validate their identity and show support
• Challenge transphobic or otherwise disrespectful remarks and behavior you may encounter in your daily life
• Advocate for gender-neutral restrooms and locker rooms in public places to create an inclusive environment
• Advocate for trans-inclusive language and policies to be implemented in your workplace, school, or community as well as policies prohibiting discrimination based on gender identity
• Support grassroots organizations working for trans equality
• Contact your local government representatives to urge them to advocate for policies that protect trans rights

Gender-affirming approaches to mental health care

A gender-affirming approach to mental health care affirms a client’s gender identity rather than trying to change it, with a focus on support and validation in a safe, nonjudgmental environment. Gender-affirming therapists can also recognize and address the increased risk of mental health challenges among transgender and gender-nonconforming individuals, such as depression, anxiety, and suicidal ideation. 

Therapeutic interventions are usually tailored to the individual’s unique needs and experiences beyond baseline mental health. Counselors will often administer a patient health questionnaire at the beginning of treatment to learn more about the person's unique needs so they can provide treatment accordingly. 

Common themes in gender-affirming mental health therapy

Although each person’s challenges are unique, the American Psychiatric Association (APA) recognizes a few core themes therapists often address with clients in gender-affirming mental health therapy. Examples of these themes include:

• Trauma
• Internalized shame
• Depression
• Self-harm
• Violence and discrimination
• Sexuality 
• Medical treatment

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Care is available online

Gender-affirming mental health care in an online setting

Trans and gender-diverse people may experience a wide range of obstacles when seeking out gender-affirming mental health care. Availability and affordability, concerns about stigma, and finding the right therapist with experience working with the LGBTQ+ community are a few examples. Online therapy platforms can often offer an effective solution to such barriers. 

Platforms like BetterHelp can connect individuals with a vast pool of therapists experienced in working with gender-diverse adults who are seeking care, with TeenCounseling offering similar services for young people. Online therapy clients may speak with their therapist remotely, from the comfort of home, on a schedule that fits their unique needs—often for a lower cost than they might be charged for traditional in-person treatment without insurance. 

Research also suggests that internet-delivered treatments like cognitive behavioral therapy (iCBT) can often be effective for treating conditions like depression and anxiety, including in trans individuals specifically. For example, one study published in Behavior Therapy in October 2024 analyzed treatment outcomes for transgender and gender-expansive individuals participating in 16 virtual sessions of LGBTQ+-affirmative CBT delivered by trained psychologists. The participants exhibited statistically significant reductions in their symptoms of depression and/or anxiety after treatment as well as decreases in minority stress factors, such as anticipated stigma and identity concealment.