Understanding Transgender Barriers To Mental Health
The transgender community is a resilient one. However, no one should have to face the marginalization that they so often do. In honor of pride month in June and minority mental health month in July, this article will discuss how transgender people face high levels of minority stress that can lead to both physical and mental health challenges.
Why Do Non-Binary People Face Mental Health Conditions At A Higher Rate?
Research shows that marginalization, violence, abuse, bullying, harassment, and stereotypes are major risk factors for mental disorders among transgender adults. Gender dysphoria (which is not a mental illness), gender identity disorder, isolation from peers, and other similar concerns are prevalent factors as well when it comes to transgender mental health. Poverty and homelessness, which transgender people are statistically more likely to face, are other risk factors for adverse mental health outcomes. Here are some of the most recent statistics connected to experiences within the transgender community:
Transgender people are six times more likely to face a mood disorder or an anxiety disorder when compared to those who are cisgender.
Transgender people are significantly more likely to experience eating disorders. found that transgender youth and transgender students in high school are three times as likely to restrict eating, almost nine times as likely to use diet pills, and seven times as likely to use laxatives to control their weight when compared to their cisgender peers.
According to this study done by the New Zealand Youth Health Survey, transgender youth are more likely to face health disparities and issues with their well-being.
Transgender people are significantly more likely to experience substance use disorders and other mental health concerns caused by substance misuse or addiction.
Young people who identify as transgender are three to four times more likely to engage in self-harming behavior.
If you or a loved one is having suicidal thoughts, reach out for help. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 and is available 24/7.
One of the most prevalent reasons that the transgender community faces mental health diagnoses and mental illness at a higher rate is connected to minority stress. Minority stress stems from the high levels of stress faced by part of minority groups that are stigmatized.
Hate crimes based on gender identity and sexual orientation have risen in recent years, and transgender lives and bodies are debated publicly, contributing to mental health issues and severe psychological distress in many people who are subject to this in their everyday lives. Violence against people who identify as transgender has worsened in the past year, with more than half of survivors being from the Black and Latin American communities. The public exposure of transgender individuals, including on Transgender Day of Visibility in March, is one of the many reasons why gender-affirming mental health care and community support are so crucial.
Why Is There A Disparity In Mental Health Care For The Transgender Community?
Despite having a higher likelihood of struggling with a mental illness, it can be more difficult to get mental health care when you identify as transgender. Here are some of the reasons that it may be difficult to ge transgender mental health care:
Fewer financial resources: In addition to being statistically more likely to face poverty and houselessness, research shows that transgender people are three times more likely to be unemployed. This means that many of them cannot afford health care, let alone mental health care, with a provider who is versed in working with their community.
Lack of specialized care: It can be difficult to find gender-affirming mental health professionals or professionals that understand your gender identity, especially in areas with less acceptance for LGBTQ+ people.
Abuse and control: Since transgender people are statistically more likely to experience both abuse* and poverty, they are often restricted from resources. This can be particularly true for youth** who are dependent on an abusive caregiver. It can also be true for people who have an abusive spouse or partner, whether they’re financially dependent on them or not.
*If you are experiencing abuse or think you might be, contact the national domestic violence hotline at 800.799.SAFE (7233) or visit https://www.thehotline.org.
**The Trevor Project is a resource for LGBTQIA+ youth. If you need support, call TrevorLifeline at 1-866-488-7386 or visit https://www.thetrevorproject.org.
Discrimination In Medical And Mental Health Care
Discrimination against transgender patients can occur in medical treatment and mental health care in a variety of ways. Here are some examples:
Restriction from hormone replacement therapy (HRT) and pubertal suppression: This may be due to difficulty finding a doctor who will prescribe HRT, financial restrictions, local laws, and rules, or blatant discrimination and bias.
Stigma and lack of recognition of diverging gender identity from their sex assigned at birth: With cisgender people at the forefront of the current healthcare model, many providers don’t have accurate information about the needs of transgender healthcare. This may be largely due to the stigma surrounding transgender people. Gender-affirming treatments are, again, often restricted and stigmatized.
A lack of trans-friendly mental health providers: Gender-nonconforming people may be refused care outright, or they may experience harassment in medical settings.
Discrimination based on gender identity can be overt, or it may be more covert. Discrimination in medical and mental health care against the transgender community leads to fear of reaching out for help. Some things that may help avoid discrimination include asking your local community for recommendations to trans-friendly providers, traveling to trans-friendly providers if possible, knowing your rights as they exist on a local level, and accompanying someone to medical appointments.
Why Do Some People Choose To Undergo Gender-Affirming Surgery, And Why Do Others Not?
We know from extensive research that gender-affirming surgeries, gender-affirming hormone therapy, and other forms of gender-affirming medical care can support and improve mental health challenges for many transgender people who are experiencing gender dysphoria and other concerns. So why do some people choose not to undergo surgery or use gender-affirming hormones?
First, there are times when it is not a choice at all, but instead a matter of whether someone has the privilege to get gender-affirming surgery. Medical problems can prevent someone from being a candidate for gender affirmation surgery. A person’s socioeconomic status can also prevent them from getting the surgery they need, even if they are a good candidate for the surgery in terms of physical and mental health.
Getting insurance coverage for gender affirmation surgery can be challenging if someone does have insurance. It’s also important to note that not every transgender person has someone around who can help them care for themselves after surgery. Not all transgender patients have the financial resources to take time off work after surgery.
Remember that not all people want gender-affirming surgeries and that every individual surgery is a personal choice. Some trans individuals want certain surgeries but choose to refrain from others due to personal preference, intricacies of gender identity, or potential risks. For example, a person may decide to get top surgery but not desire bottom surgery. Some people are happy with the results of HRT alone, but like surgery, there are trans people who don’t use HRT for various reasons. What a person desires to do in gender-affirming care is unique to their trans identity and should be respected. Your gender identity is valid whether or not you have pursued surgery.
Self-Care And Support For Transgender People In And Outside Of Primary Care Settings
Gender-affirming mental health care can be revolutionary for improving mental health disparities. Gender identity is not the only thing you can talk about with gender-affirming counselors or therapists; finding a therapist who works with trans people allows you to talk about anything regarding how gender identity informs your mind. However, again, not everyone can get care, nor is everyone ready. Here are some other modalities of self-care and support:
Find community: You may visit the local LGBTQIA+ resource center, look for a community online, join a support group or an alliance, or meet other transgender people through other means. Having community matters because you can get knowledge and resources, a sense of understanding, and so much more.
Use self-help resources: These may include books, workbooks, podcasts, or something else. Looking for media and self-care resources created by other transgender people can be incredibly cathartic as well.
If you need immediate support, contact a hotline: There are hotlines designated specifically for LGBTQIA+ individuals that you may reach out to. The trans lifeline was created for and by transgender people. They also have a lifeline for friends and families who need help supporting a non-binary loved one.
Suppose you live with gender dysphoria, want to find an affirming therapist to work with, and aren’t sure where to start. In that case, you may search for terms like “gender-affirming therapist near me,” “transgender group therapy near me,” “transgender therapist near me,” or sign up for an online therapy platform like BetterHelp, where providers have a wide range of specialties, including specialties in working with specific demographics. Many people in the trans community may prefer meeting with an online therapist because of the flexibility that platforms like BetterHelp provide with appointment scheduling. Additionally, being able to attend a therapy session from a preferred location can help the person feel more confident and safe, as they may have previously encountered discrimination or stigma when visiting an in-person therapist’s office for the first time. Online therapy is also viewed as a more cost-effective option, which can be advantageous for trans people who are going through expensive gender-affirming surgeries.
While more research needs to be conducted with regard to the efficacy of online therapy as a therapeutic intervention for people who identify as transgender, some studies have already shown promise in an ability to support transgender people who go through various psychological challenges. In one randomized controlled study, researchers sought to evaluate the effectiveness of online therapy in improving mental health by supporting lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity affirmation, coping self-efficacy, and coping skill practice. 270 gender minority youth ages 13 to 19 participated in the study, and 78% identified as racial or ethnic minorities. At week four, the retention was over 90%, and participants in the treatment group reported greater satisfaction with the intervention than those in the control group. These results qualify as initial evidence that internet-based interventions show potential for supporting gender minority youth in coping with minority stress. While BetterHelp is designed for adult use, transgender youth may seek therapeutic services via BetterHelp’s partner site – TeenCounseling.
Read below for some reviews of BetterHelp therapists, from people who identify as trans.
“Robin is amazing. After years of trying to find a therapist who I felt understood the unique issues facing myself as a trans woman, they are a real breath of fresh air.”
“Tracey is hands-down the best counselor I’ve ever worked with. She utilizes REBT methods with such ease, I hardly realize she’s doing it! She is very easy to talk to and incredibly supportive. I greatly appreciate our sessions, and I feel like the work we’ve done impacts my life in a positive and tangible way. Her experience with career counseling is apparent, and her cultural competency should be commended. As a trans man, it is often hard to find counselors that walk the talk. Tracey is clearly an active advocate for marginalized communities, and incredibly personable. 11/10, forever grateful for her service.”
How Can Others Be Allies?
First and foremost, it is important to listen to transgender people. They are experts in their own experiences, and anything that impacts them should also include them. Support and hire transgender educators, writers, speakers, and so on to cover related topics.
Here are some additional ways to work toward allyship:
Fight for transgender rights: Vote against anti-trans laws and learn the facts about how they impact the community and mental health care. Click here to track current anti-transgender legislation in the United States.
Debunk stereotypes: While the media often mainly shows one appearance for people with the privilege to get HRT, transgender people can take any appearance. Stand up for and acknowledge the trans community as a whole, including those who aren’t on HRT, those who have inconsistent or limited mental health and physical health care or can’t get care, those who are gender-expansive or gender non-conforming, and so on.
Use the correct name, pronouns, and other identifiers related to gender identity: If someone tells you to use a specific name and set of pronouns, use them, and correct yourself when you slip up.
Work toward inclusion in the workforce and workplace: Again, listen to transgender people who have spoken up about the most effective ways to do this.
Stand up for youth: Learn the facts about puberty blockers (these are prescribed to both cisgender and transgender children to delay puberty, but transgender children are the ones who tend to be restricted from this necessary and potentially life-saving form of care) and advocate for the rights of transgender children in schools, on sports teams, and so on. Research shows that supporting the gender identity of transgender children is positive for their well-being.
Turning toward other transgender people in your area and asking about providers, clinics, and community resources with which they’ve had positive experiences may be advantageous. Your gender identity should be embraced and respected by any provider you see. By taking the initial questionnaire on BetterHelp, you can get matched with a licensed, empathetic therapist who is uniquely qualified to support you in getting the resources and support you need – take the first step today.
Frequently Asked Questions
How Does Gender Play A Role In Mental Health?
Gender plays a significant role in mental health. Many people do not identify with the sex they were assigned at birth, and this can lead many trans individuals to experience gender dysphoria. According to the American Psychiatric Association, gender dysphoria is “psychological distress” arising out of this difference in sex and gender. Most people who experience gender dysphoria develop it at an early age, and gender nonconforming youth can live with particularly severe psychological distress. Their gender expression may still be conforming because they don’t feel comfortable outwardly displaying that they are gender diverse or gender fluid. This mismatch between their self-image and the image they’re displaying to the world can cause confusion and may lead to mental health concerns.
Luckily, there are treatment options for those who are living with gender dysphoria, including mental health care and care for transgender health performed in a clinical setting, such as gender-affirming surgery. Gender-affirming surgery allows a person transitioning from the sex they were assigned at birth to undergo a procedure that transitions their body to more closely match the gender with which they identify. For people living with gender dysphoria, this procedure can help establish a sense of self, alleviate concerns about discrimination, and improve mental health. One study showed that people who had undergone gender-affirming surgery experienced decreased depression after treatment.
Even with treatment, however, there are still many things that can affect those in the trans community. Because of the social stigma that still exists, relationships between families and friends often become strained as a result of a person’s transgender identity. That being said, those living with gender dysphoria can also reach out to gender-affirming therapists, who know how to work through mental health challenges that are specific to the transgender community.
What Are The Biological Sexes?
The actual number of biological sexes is the subject of much scientific debate. While some people believe there are only two sexes, others believe that there are many more than that. Some people have chromosomes that would identify them as male or female but sex organs that would identify them as the other sex. These disorders of sex development make it difficult to classify certain people as being strictly of the male or female sex. Here are some of the six most common karyotypes:
XX – two X chromosomes represent the most common form of the female sex
XY – one X and one Y chromosome represent the most common form of the male sex
XXY – two X chromosomes and one Y chromosome occurs in roughly 1 in 500 to 1 in 1,000 people and is known as Klinefelter syndrome
XYY – one X chromosome and two Y chromosomes occurs in approximately 1 out of 1,000 people
XXXY – three X chromosomes and one Y chromosomes is extremely rare, occurring every 1 in 18,000 to 1 in every 50,000 births
In Turner syndrome, one of the X chromosomes is missing or partially missing; as far as prevalence, this occurs in 1 out of every 2,000 to 2,500 live births.
Can you get depression from gender dysphoria?
What does gender dysphoria feel like?
What is the biggest barrier to healthcare for transgender individuals?
What are three barriers to receiving mental health treatment?