Introduction
For many transgender individuals, living in a body that doesn’t align with their true sense of self can cause significant distress. The term "transgender" covers people whose gender identity, gender expression, or behavior doesn’t match the sex they were assigned at birth (American Psychological Association, 2024).
Gender identity is different from gender expression. Gender identity refers to someone’s internal sense of being male, female, or something else, while gender expression is how they present that identity through things like accessories, clothing, behavior, or appearance.
Not everyone who shows gender-nonconforming traits identifies as transgender, but for some of those who do, gender dysphoria, the discomfort that arises from the mismatch between their gender identity and sex assigned at birth, can deeply affect their mental health (Turban, 2022). This often leads to struggles with anxiety, depression, and feelings of isolation.
As therapists and mental health professionals, it’s crucial to create a space where transgender clients feel understood and supported. Gender-affirming medical care that respects their identity can help reduce these mental health challenges and support them in navigating their journey with greater resilience and well-being.
Mental health concerns in the transgender community
Transgender people face unique mental health challenges. In fact, transgender and gender-diverse youth significantly experience higher rates of depression, suicidality, and substance use compared to their cisgender (someone whose gender identity matches their sex assigned at birth) sexual minority peers. These issues are compounded by trauma, victimization, and discrimination while also being hindered by barriers to accessing gender-affirming care (Moagi et al., 2021; Newcomb et al., 2019). Here are some specific concerns in detail:
Emotional distress and stigma
Transgender people often experience emotional distress due to a disconnect between their gender identity and societal expectations. Stigmatization and victimization can worsen this, leading to feelings of shame, anxiety, and depression, which significantly impact their overall mental health.
Discrimination and violence
Discrimination and violence, including childhood sexual abuse and trauma, are common experiences among transgender individuals. These harmful experiences can contribute to the development of mental health disorders, including post-traumatic stress disorder, anxiety, and depression, creating a cycle of distress that is difficult to break.
Barriers to healthcare access
Many transgender people face obstacles when seeking healthcare, including discrimination from medical professionals and a lack of access to care. This can lead to untreated health conditions and an increased risk of mental health issues, as they may avoid care altogether due to fear or past negative experiences.
Substance use and coping mechanisms
To cope with the overwhelming stress of discrimination and gender dysphoria, some transgender individuals turn to substance use, including cigarettes, alcohol, and illicit drugs. This behavior can further exacerbate their mental health struggles, leading to a vicious cycle of substance dependence and emotional distress.
Factors that cause or affect mental health issues in the community
When we talk about mental health in the transgender community, it’s crucial to consider the various factors that can shape or worsen mental health outcomes. These factors are complex, but some key influences stand out, such as:
Social stigma and discrimination
Social stigma and discrimination are major contributors to poor mental health outcomes in the transgender community. Experiencing rejection, bullying, and prejudice from society can lead to chronic stress, low self-esteem, and feelings of alienation. For many transgender individuals, this stigma can persist throughout their lives, compounding mental health challenges and affecting their ability to thrive.
Lack of education and awareness
A widespread lack of education and awareness about transgender identities fuels misunderstanding, fear, and bias. When uninformed, people may unknowingly contribute to microaggressions or harmful stereotypes. This ignorance can isolate transgender individuals and negatively impact their mental health over time.
Family and social support
The presence or absence of family and social support plays a crucial role in transgender individuals' mental health. When transgender people receive acceptance and encouragement from family, friends, and their community, it can buffer the negative effects of discrimination and improve mental health outcomes. On the other hand, rejection or lack of support can deepen feelings of isolation, leading to heightened mental health struggles.
How to provide support to the transgender community
Supporting the transgender community requires understanding, compassion, and commitment to delivering inclusive care. Here are some ways to make a meaningful impact.
Provide access to healthcare
One of the most important ways to support transgender individuals is by ensuring access to gender-affirming treatments. These help alleviate gender dysphoria and reduce the risk of adverse mental health outcomes by helping individuals align their bodies with their gender identity.
One method, gender-affirming hormone therapy, was found to help improve quality of life and reduce depression and anxiety in transgender individuals, based on findings from 20 studies (Baker et al., 2021).
Use inclusive and respectful language
Always use the name and pronouns that a transgender person prefers, as this shows respect for their gender identity. Misgendering can contribute to mental disorders and feelings of isolation, while affirming their identity promotes positive mental health and self-esteem.
Offer mental health support
Transgender individuals often face challenges such as discrimination and societal rejection, leading to mental health struggles like depression and anxiety. Providing access to therapists who are experienced in supporting transgender people can help mitigate these mental health challenges and improve their emotional well-being.
Respect sexual orientation and identity
Recognize that gender identity and sexual orientation are distinct aspects of a person's identity, and offer support regardless of their sexual orientation. Being nonjudgmental and open-minded about their experiences ensures a safe space for transgender individuals to express themselves freely.
Conclusion
Caring for transgender clients means meeting them with respect, openness, and a genuine willingness to understand their experiences. Many face real challenges that can impact their emotional well-being, from feeling unseen to facing rejection or limited access to care.
As mental health professionals, creating safe and affirming spaces can make a difference. With steady support and compassionate guidance, we can help people feel more at home in themselves and the world around them.
References
American Psychological Association. (2024, July 8). Understanding transgender people, gender identity and gender expression. https://www.apa.org/topics/lgbtq/transgender-people-gender-identity-gender-expression
Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021). Hormone therapy, mental health, and quality of life among transgender people: A systematic review. Journal of the Endocrine Society, 5(4). https://doi.org/10.1210/jendso/bvab011
Moagi, M. M., Der Wath, A. E. van, Jiyane, P. M., & Rikhotso, R. S. (2021). Mental health challenges of lesbian, gay, bisexual and transgender people: An integrated literature review. Health SA Gesondheid, 26(1487). https://doi.org/10.4102/hsag.v26i0.1487
Newcomb, M. E., Hill, R., Buehler, K., Ryan, D. T., Whitton, S. W., & Mustanski, B. (2019). High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults. Archives of Sexual Behavior, 49(2). https://doi.org/10.1007/s10508-019-01533-9
Turban, J. (2022, August). What is gender dysphoria? American Psychiatric Association. https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria
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