Understanding Transgender Mental Health: Barriers And Resiliency

Updated January 11, 2022

The transgender community is a resilient one. However, no one should have to face the marginalization that transgender people so often do. Transgender people face high levels of minority stress that can lead to both mental and physical health problems.

You Deserve To Live An Authentic Life And Feel Supported

Research shows us that:

  • 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. One study found that transgender college students are five times more likely than their cisgender peers to experience an eating disorder.
  • Transgender people are significantly more likely to experience Substance Use Disorder.

Why Do Transgender 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 health conditions. Gender dysphoria, isolation from peers, and other similar concerns are prevalent factors as well. Poverty and homelessness, which transgender people are statistically more likely to face, are other risk factors for mental health conditions.

In short, one of the most prevalent reasons that transgender people face mental health conditions at a higher rate is minority stress. Minority stress stems from the high levels of stress faced by members of minority groups that are stigmatized.

Hate crimes based on gender identity have risen in recent years, and transgender lives and bodies are debated publicly, leading to mental health issues in many transgender people who are subject to this in their everyday lives. The public exposure of transgender individuals is one of the many reasons that gender-affirming mental health care and community support are so crucial.

Why Is There A Disparity In Mental Health Care For The Trans Community?

Despite having a higher likelihood of struggling with a mental health condition, it can be more difficult to access mental health care as a transgender person. Here are some of the reasons that it may be difficult for the trans community to access 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 transgender people cannot afford health care, let alone mental health care, with a provider who is versed in working with transgender people.
  • 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 transgender people.
  • Abuse and control. Since transgender people are statistically more likely to experience both abuse* and poverty, transgender people 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 Against The Transgender Community

Discrimination against the transgender community can occur in medical and mental health care in a variety of ways. Here are some of them:

  • Restriction from hormone replacement therapy (HRT) and puberty blockers. This may be due to difficulty finding a doctor who will prescribe HRT, financial restrictions, local laws, and regulations, or blatant discrimination and bias.
  • Stigma and lack of recognition. With cisgender people at the forefront of the current healthcare model, many providers don’t have accurate information about the needs of transgender people or transgender healthcare. This may be largely due to the stigma surrounding transgender people and that transgender people are often treated as a rarity. Gender-affirming care for transgender people is, again, often restricted and stigmatized.
  • A lack of trans-friendly providers. Transgender and 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 as a transgender person. Some things that may help avoid discrimination are 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 surgery, hormone replacement therapy, and other forms of care can support and improve mental health for many transgender people. So why do some people choose not to undergo surgery?

First, there are times when it is not a choice at all, but instead a matter of if someone has the privilege to access gender-affirming surgery. Medical problems can prevent someone from being a candidate for 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 health. Getting insurance coverage for gender-affirming surgery can be tough 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 people have the financial resources to take time off of work after surgery.

Remember that not all transgender people want gender-affirming surgery and that every individual surgery is a personal choice. Some transgender people 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 hormone replacement therapy (HRT) alone, but like surgery, there are transgender people who don’t use HRT for various reasons. What a person desires to do in gender-affirming care is unique to the individual 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 Healthcare Settings

Gender-affirming mental health care can be revolutionary for transgender people. Gender identity is not the only thing you can talk about with gender-affirming counselors or therapists; finding a therapist who works with transgender people allows you to talk about anything regarding how gender identity informs your mind. However, again, not everyone can access care, nor is everyone ready. Here are some other modalities of self-care and support for transgender people:

  • Find community. You may visit the local LGBTQIA+ or transgender 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 share 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 friend and a family lifeline if you need help supporting a transgender loved one.

Suppose you 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,” “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. Again, 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. 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.”

Learn More About Robin Sweeney

“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.”

Learn More About Tracey Singer

How Can Others Be Allies For The Transgender Community?

First and foremost, listen to transgender people. They are experts in their own experiences, and anything that impacts transgender people should include transgender people. Support and hire transgender educators, writers, speakers, and so on to cover transgender 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 transgender people. Click here to track current anti-transgender legislation in the United States.
  • Defeat stereotypes. While the media often mainly shows one appearance for transgender people with the privilege to access Hormone Replacement Therapy, transgender people can take any appearance. Stand up for and acknowledge the transgender community as a whole, including those who aren’t on HRT, those who have unstable access to care or can’t access 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 transgender children. 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.

Everyone deserves for their gender identity to be embraced. Learn about different gender identities and how to best support transgender people.

For Additional Help & Support With Your Concerns
Speak with a Licensed Therapist Today
The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.