Transgender Depression Risk And The Benefits Of Gender-Affirming Mental Health Care

People living with marginalized identities are typically at higher risk of experiencing mental health challenges due to their lived experiences of discrimination. Transgender individuals, or those who do not identify with the gender they were assigned at birth, may be at particular risk due to the way trans and gender non-conforming identities are specifically attacked and legislated against today. As a result, more than half of gender-diverse and transgender people currently live with a depressive disorder. Here, we’ll explore more about depression in the trans community and outline how members of this community can receive affirming mental health support.

Defining gender identity

A person’s gender identity is their own internal sense of self and gender. A person may express their gender through hair, makeup, clothing, body language, and other elements (known as “gender expression”). It’s common for a person to be assigned a gender at birth based on the biological characteristics that doctors perceive, but gender identity is something an individual perceives about themselves. Individuals who are transgender, non-binary, or otherwise gender non-conforming (GNC) do not align with the gender they were assigned at birth. 

While trans and GNC individuals have existed throughout human history, these identities are heavily persecuted and marginalized today, particularly in western society. As a result, individuals are often heavily pressured to live as the gender they were assigned at birth and discriminated against if they express any gender identity outside of this or the gender binary in general. These strict “rules” and the consequences by which they are enforced can contribute to significant mental health challenges for trans and GNC individuals.

The impacts of gender incongruence

One potential contributor to mental health challenges among trans and gender-diverse people is the effects of gender incongruence. Studies suggest that people experiencing gender incongruence—a difference between a person’s experienced gender and the one they were assigned at birth—are six times more likely to be diagnosed with a mood or anxiety disorder. Rather than mental health challenges being inherent to those with a LGBTQ+ identity, it’s the social pressures that often make it difficult for people to live openly as themselves that tend to cause or exacerbate stress. 

A note on the impacts of intersecting identities

This is the essence of a concept known as intersectionality, since such individuals tend to experience these additional barriers at the intersections of multiple identities. 

How discrimination and stigma can contribute to depression

Stigma and discrimination against transgender individuals may increase their risk of developing depression. These prejudices can appear in any facet of life, from social settings to the workplace to housing and healthcare. Transgender individuals who experience discrimination are more likely to develop depression, post-traumatic stress disorder (PTSD), high stress levels, and suicidal thoughts.

In the workplace

Discrimination often extends into the workplace, impacting many transgender adults’ career prospects and financial stability as well as their mental health. Transgender people often face workplace violence, harassment, and hostility. In order for all to feel safe and supported at work, it can be important for workplaces to foster a culture of inclusivity and respect.

Barriers to receiving gender-affirming health care

Healthcare institutions and systems can also make it more difficult for transgender populations to receive care. Healthcare professionals often hold prejudices themselves and may lack training and education surrounding transgender needs, especially during a transition. This may deter trans and gender-diverse individuals from seeking mental, emotional, and physical health support. Plus, transgender people—especially those with multiple marginalized identities, like trans individuals of color—tend to also be economically marginalized, which can impact their ability to receive affordable and available healthcare in their area. 

Gender-affirming care for reducing the risk of transgender depression

In the broadest sense, gender-affirming care is any type of healthcare throughout which the provider is sensitive to and validating of the individual's identity. This can look like using a patient's preferred name and pronouns, not pathologizing their identity, and being informed on and mindful of the historic harms that LGBTQ+ individuals and people of color have experienced in healthcare settings. 

For transgender individuals, gender-affirming care is associated with lower odds of depression and suicide. Gender-affirming care can include hormone therapy, social transition support, surgical gender-affirming care, mental health support, and more. Each of these interventions can support a transgender individual's true identity, often boosting general well-being and enabling authentic living. However, there are often political restrictions, financial barriers, and a lack of availability of this care for many. 

Gender-affirming mental health care as a public health responsibility

When mental health professionals have received specialized education for supporting transgender individuals, they may be able to recognize and address challenges that trans people are often at risk of today, such as gender dysphoria, trauma, and discrimination. Therapists who specialize in gender-affirming care can help transgender individuals navigate both internal and external challenges. 

Examples of public health initiatives that may help enhance transgender mental health

Various public health initiatives can be implemented to enhance the well-being of the transgender population at large. For example, a recent study on medical professionals providing transgender health care suggests that a single educational seminar led to improved proficiency in providing care. 

Some examples of public health initiatives that could enhance mental health in the transgender community include:

• Providing training for healthcare professionals. Teaching healthcare providers how to approach transgender and gender-diverse patients with compassion and sensitivity can reduce stigma and foster trust in healthcare environments. 
• Improving availability of gender-affirming care. Making it easy for individuals to receive various treatments when they want to, such as gender-affirming hormone therapy, may help ease gender dysphoria and enhance mental health.
• Supporting transgender-led organizations. Collaborating with and raising funds for transgender women, men, and non-binary individuals who are running small businesses, organizations, and campaigns can be a significant form of support. 
• Addressing health disparities. Raising awareness of mental health disparities between the transgender population and the overall population can allow for effective health interventions to be researched and implemented.
• Promoting inclusivity. Encouraging inclusive language in school, work, and community settings can help all individuals feel safe, supported, and accepted. Inclusive language can help affirm identity and reduce the risk of adverse mental health outcomes. 
• Developing youth-focused outreach. Creating inclusive, safe programs for transgender youth to seek guidance and support can be an important preventative measure for youth mental health.

The role of social support in reducing the risk of transgender depression

Research has long suggested that having strong social support can be a protective factor against the risk of depression, and this can also be true for transgender and gender-diverse individuals. Many of the challenges that transgender people face are a consequence of social and political factors. 

While the current climate can make it more difficult for individuals in this population to find and build strong social support networks, the effects of doing so can be significant. For example, for transgender youth, research suggests that parental support can improve quality of life and protect against depressive symptoms. Receiving mental health support that affirms a person’s gender identity and sexual orientation can also be key.

Online therapy for transgender mental health

Again, compassionate, informed, and affirming mental health care can sometimes be difficult for transgender and GNC individuals to find, particularly for those who do not live in or near a major metropolitan area. It’s also worth noting that some transgender individuals may not feel safe or comfortable commuting to in-person therapy appointments and meeting with a new provider face to face. In both cases, online therapy can represent a more comfortable, convenient, and readily available form of care.

With a platform like BetterHelp, an individual can get matched with a licensed therapist according to their needs and preferences as outlined in a brief onboarding patient health questionnaire. Once matched, you can meet with your provider remotely from anywhere you have an internet connection. You can choose from phone, video, or in-app messaging for your appointments, depending on your comfort level. You can also switch providers at any time at no additional cost until you find a therapist who feels like the right match.

The effectiveness of online therapy for depression

A growing body of research suggests that online therapy may often be effective for treating symptoms of depression. Additional research on virtual care for members of the LGBTQ+ community specifically suggests that affirming therapy can often be effectively delivered online.

Takeaway

Individuals in the transgender community—who tend to face systemic barriers, discrimination, and stigma—are more likely to experience poor mental health as a result. To improve mental health, it’s important that transgender individuals can receive gender-affirming care. To build a more compassionate and understanding healthcare system, public health initiatives might use inclusive language, support transgender-led organizations, and more. Today, mental health professionals who specialize in gender-affirming care may be available both in-person and online to support transgender mental health.