Transgender: Ensuring Mental Health

What is transgender?

Healthcare providers assign a baby a sex at birth. Babies may be assigned female at birth (AFAB) or assigned male at birth (AMAB) based on their external physical genitalia. The term “cisgender” describes people who identify as the gender that matches their assigned sex. (For example, if you’re born biologically female and you identify as female, then you're cisgender.) But for some people, as they grow up and understand themselves better, they find that their gender doesn’t match their assigned, biological sex.

The definition of transgender is evolving with new generations. The term “transgender” falls into the broad category of “gender diverse.” A person who identifies as trans may be:

• A trans man who is AFAB but identifies as male.
• A trans woman who is AMAB but identifies as female.
• Nonbinary, genderqueer, gender fluid, Two-Spirit or another term that describes a person who identifies as neither (or both) male or female, a third gender or genderless.

A person who is intersex has biological characteristics of both sexes. Some, but not all, intersex individuals identify as transgender. The two terms aren’t interchangeable.

What effect does being transgender have on a person’s mental health?

Some trans individuals don’t experience mental health issues at all. Others have mental health issues that aren't related to being transgender. But for some, mental health and gender identity are related. Generally, this isn’t due to being transgender, but to the social stigma that often exists.

Transgender children, adolescents and adults often face discrimination and other challenges in society. If you’re transgender, you may feel unwelcome at home, school, work or in social settings. More than half of transgender students who are out (publicly open about their transgender status) in K-12 school experience verbal harassment. One in 4 experience a physical attack, and more than 1 in 10 are sexually assaulted.

Among transgender adults, almost half report being verbally harassed in the past year. And 1 in 10 are physically attacked or sexually assaulted in a given year. Trans people may also experience:

• Bullying.
• Discrimination.
• Harassment or intimidation.
• Prejudice.

As a result of these painful and traumatic experiences, 39% of trans individuals report experiencing severe psychological distress. By comparison, only 5% of the general U.S. population report this type of distress.

Is being transgender a mental illness?

No. Being transgender (or trans, for short) isn't a mental health disorder. If you’re transgender, it means that you have a different gender identity than the one you were assigned at birth. (Gender identity is defined as the personal sense of one’s own gender.) The desire to convey your gender in the way you feel most authentic is a normal aspect of human expression.

What is gender dysphoria, and how does it affect trans people?

Gender dysphoria is a condition that affects many transgender people before they transition (begin living as their authentic selves). It describes a sense of unease regarding the mismatch between assigned sex and gender identity — and it can occur at any point during life, from childhood to adulthood. Left untreated, gender dysphoria can lead to severe emotional and psychological distress.

Gender dysphoria can lead to other mental health challenges, including:

• Anxiety.
• Depression, sadness or a sense of loss.
• Negative self-image or poor self-esteem.
• Post-traumatic stress disorder (PTSD).
• Shame.
• Social isolation.

The social stigma that many trans people face can cause them to feel unwanted or overwhelmed. They may try to ease these feelings with harmful behaviors that can result in:

• Alcoholism.
• Drug addiction.
• Eating disorders.
• Self-injury.
• Suicidal behavior.

If you or someone you know is experiencing suicidal thoughts, seek emergency help. The National Suicide Prevention Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, seven days a week, at 800.273.8255.

If you need help for a substance use disorder, SAMHSA’s National Helpline, 800.662.4357, offers confidential, free help in English or Spanish, 24 hours a day, 365 days a year. It provides referrals to local treatment facilities, support groups and community-based organizations.

Are trans people more likely to experience other mental health disorders?

Research indicates that transgender people are somewhat more likely to have a psychiatric diagnosis. The most common are anxiety and depression. But some conditions are more common among trans people, including:

• Bipolar disorder.
• Borderline personality disorder.
• Dissociative identity disorder (multiple personality disorder).
• Obsessive-compulsive disorder.
• Schizophrenia.
• Schizoaffective disorder.

What are some healthy ways for transgender people to cope with mental health issues?

The first step often includes finding a mental health provider you trust. You or your trans child may feel more comfortable with a provider specializing in transgender issues. Sharing details about your life with someone who understands your needs can help you heal faster.

If you experience gender dysphoria, you may wish to explore options for expressing your authentic gender identity. Your mental health provider can help you work through concerns and come up with a plan. Doing so can help you feel more confident and move forward with your life.

You can support your own mental health by:

• Getting plenty of sleep.
• Surrounding yourself with supportive people and avoiding harmful ones as much as possible.
• Eating a nutritious diet and avoiding substance misuse.
• Practicing meditation or other stress-reduction techniques.
• Getting regular exercise such as walking or yoga.

How can I find a mental health provider who's comfortable and competent in working with transgender people?

Your mental health is critical to your well-being. It’s important to find a provider with whom you can speak openly. There are many ways to search for providers:

• Ask your healthcare provider to recommend a counselor or referral service.
• Call your insurance company and ask about providers specializing in trans mental health.
• Contact your local LGBTQ+ center or look at their website for recommended therapists.
• Request referrals from transgender online social communities.
• Ask for suggestions from trans or LGBTQ+ friends (if you have an LGBTQ+ community in your life — not everyone does).
• Find a therapist in another community and ask if they offer video visits.

You can also reach out for help to trusted national organizations. These include:

• PFLAG offers resources for families and friends of trans people, and focuses on building a network of allies in communities across the country. To learn more, find a PFLAG chapter near you.
• The Trevor Project has trained counselors to help young people who are in crisis, feeling suicidal or in need of a safe, judgment-free place to talk. Call the TrevorLifeline (1.866.488.7386) or text START to 678-678.
• Trans Lifeline offers direct emotional and financial support to trans people in crisis. It was created for the trans community, by the trans community. If you are in crisis, call the Trans Lifeline at 1.877.565.8860.

How can a mental healthcare provider help me or my transgender child?

A mental health provider can help you understand and find healthy ways to explore or express your gender identity. They can provide individualized care to help you:

• Explore your identity and what it means to you.
• Decide how you wish to express your identity, both socially (how you dress, your hairstyle or choice of make-up, or the name or pronoun you choose to use) and medically (including the use of hormone medications or gender affirmation surgery).
• Help you plan for disclosing your affirmed gender identity (coming out) to the people who are important to you.
• Support you as you transition to your affirmed gender identity.
• Navigate relationships with friends, loved ones and coworkers after coming out.
• Learn healthy ways to cope if you encounter rejection and social stigma.
• Manage unpleasant feelings using stress management techniques, medications or other methods.
• Find helpful community resources, including support groups and other transgender healthcare providers.

How can I help support my transgender child’s mental health?

If your child has gender dysphoria, you can help them find comfortable, healthy ways to express their identity. Family and youth support groups can be helpful. It’s also important to find a healthcare provider who can support your child’s overall well-being.

Some children and teens wish to prepare for hormone therapy or gender-affirming surgery when they are older. Some want to change their name, pronouns or the bathroom they use at school. Others prefer to express their gender difference at home but not in school. Let your child lead the way. The most important thing is to support your child and listen to their needs.

Do I need gender-affirming surgery to feel better about myself?

This is a highly personal decision. You’re the only one who can decide what’s right for you. While some people choose gender-affirming surgery, it isn’t necessary if you don’t want it. Many trans individuals feel they can represent themselves — and maintain healthy self-esteem and self-image — with a nonsurgical approach.

Nonsurgical transition may include:

• A new name, pronouns or both.
• Cosmetic procedures, like injectables and fillers to make your face appear more feminine, masculine or neutral.
• Dressing and grooming in a manner consistent with your affirmed gender identity.
• Feminizing hormone therapy or masculinizing hormone therapy to reshape your body.

If I want gender-affirmation surgery, how can a mental health provider help me?

If you're considering surgery, therapy may be an insurance requirement. Speaking with a mental health provider can help show that you:

• Understand the long-term effects of surgery.
• Are mentally capable of agreeing to the procedure.

How can I support a loved one who is transgender and showing signs of a mental health issue?

Having a mental health issue is often a lonely experience. The first thing you can do is to let your loved one know you're there for them. Even if you don’t know the specifics of their struggles, this simple act can make a difference.

Here are some other steps you can take:

• Use their chosen pronouns and name.
• Don’t share information about their gender or their transition without their permission.
• Express your concern for their well-being and your desire for them to live a happy life.
• Ask how you can help them feel understood.
• Offer to go with them to appointments or check-in afterward if you can’t be there in person.
• Have patience and know that the healing process takes time.

A note from Cleveland Clinic
Mental health is a state of well-being that everyone deserves. If you're transgender, you may face gender dysphoria and discrimination, which can affect your mental wellness. Many trans individuals can experience anxiety, depression, sadness and isolation. Receiving help from a mental health professional who specializes in gender identity can help you feel better. They work with you to get to the source of negative feelings. They can also assist you in progressing toward your affirmed gender identity.