Mental health concerns are common – about 1 in 5 people have one within any given year. But the rates within the transgender community are even higher. Many trans people have one or more mental health disorders.
There are different reasons why trans people are more likely to have mental health concerns. And, sadly, most of them relate to living in a world that’s not kind to people who are transgender. Instead of being loved and respected for who they are, people who are transgender often experience bias, prejudice, discrimination, threats of personal harm and acts of violence.
If you have mental health concerns, support from friends, family and even a therapist can make all the difference. But unfortunately, not everyone who is transgender has a support system they can rely on.
The good news is there are things you can do to help. Read on to learn about mental health challenges in the trans community, why they happen and what you can do to make a difference.
But first, what is transgender?
Transgender is an umbrella term for people whose gender identity or gender expression differs from the cultural and societal expectations of the binary sex they were assigned at birth. A person who is transgender may be a:
- Trans man or boy – A person assigned female at birth who identifies as a man or more masculine.
- Trans woman or girl – A person assigned male at birth who identifies as a female or more feminine.
- Nonbinary – A person who doesn’t describe their gender identity exclusively as a man or a woman.
Transgender mental health concerns
To be clear, being transgender is not a mental illness. But people who are transgender do struggle with higher levels of depression, anxiety and thoughts of suicide than the general population. People who are transgender also have the highest rates of mental health challenges among people who identify as LGBTQ. Specific mental health concerns include:
Anxiety within the transgender community
According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental health concern in the United States, affecting about 1 in 5 adults.
Within the transgender community, rates of anxiety are much, much higher. In fact, some studies show that nearly everyone who is transgender is living with anxiety.
- Over 90% of transgender Minnesotans feel anxious at least one day per week and nearly half feel nervous, anxious or on edge 5-7 days per week, based on the Rainbow Health survey.
- Up to 79% of trans kids experience anxiety, based on the results of the Trevor Project’s national survey of LGBTQ youth.
Depression within the transgender community
Everyone feels down every now and then. But for some people, feelings of sadness make it difficult to enjoy life. Based on surveys, most people who are transgender feel depressed at least once a week.
- About 85% of Minnesotans who are transgender feel depressed weekly, and 36% feel down at least five days per week, according to the Rainbow Health survey.
- Up to 69% of trans youth experience symptoms of depression, according to the Trevor Project survey.
In comparison, about 5-6% of the general population experiences regular feelings of depression.
Suicide rates for transgender community
There’s no single reason why people consider suicide – and it’s more common than we’d like it to be. According to the American Foundation for Suicide Prevention, about 0.5% (or 1 in 200) adults have made at least one suicide attempt.
Unfortunately, the transgender suicide rate is even higher. More than half of transgender youth considered suicide in 2021 and nearly 1 in 5 attempted suicide, according to the Trevor Project survey.
Why are mental health challenges more common among transgender people?
For people who are transgender, the reason for mental health challenges is usually a combination of factors – both internal and external.
For example, a study looking at reasons for suicidal thoughts in transgender youth found that “school belonging, emotional neglect by family, and internalized self-stigma made a unique, statistically significant contribution to past 6-month suicidality.”
Other factors that contribute to increased rates of mental health disorders within the trans community include discrimination, transphobia, financial instability and health challenges.
Many transgender people experience an emotional condition known as gender dysphoria. If someone has gender dysphoria, they experience significant distress because their inner sense of self doesn’t match their sex assigned at birth and their body. For example, a trans man may be distressed about having breasts because they don’t belong on his body. He may also experience frequent misgendering and assumptions of his gender identity because he has breasts.
Gender dysphoria disrupts a person’s ability to function in day-to-day activities like work or social events. It can also lead to mental health conditions such as anxiety, depression and chronic stress.
Gender dysphoria is most commonly experienced before someone takes steps to align their life – and sometimes their body – with their gender identity. When someone make changes to affirm their gender identity, the distress from gender dysphoria usually gets better or goes away entirely.
Lack of support from friends and family
Not everyone is understanding and accepting when a person decides to transition – less than 1 in 3 homes are gender-affirming for transgender youth, according to the Trevor Project survey.
When a trans person starts to express their gender identity, they may be bullied, disrespected and not accepted by their loved ones. Families who aren’t supportive may refuse to acknowledge a person’s chosen name and pronouns. They may also be unwelcoming or hostile to LGBTQ friends and partners. Sadly, when trans youth don’t feel supported, they’re more likely to consider or attempt suicide.
Even more startling, more than 1 in 5 transgender youth said they’ve been threatened with or subjected to conversion therapy to “cure” their gender identity so that it matches the one they were assigned at birth. But conversion therapy is unethical and doesn’t work. It is also damaging to a person’s mental health, increasing the risk of depression, anxiety and suicide.
Feelings of isolation or loneliness
If a trans person is afraid of the reaction of friends and family, they may not tell anyone about their gender identity and feelings. They may spend less time with others or dread family gatherings because they believe no one will support and accept them for who they truly are. Keeping such an important part of yourself blocked from others can make you feel lonely and isolated.
Loneliness can have a big impact on mental health, increasing your chance of depression, anxiety and low self-esteem. In the Rainbow Health survey, about 85% of trans people said they felt lonely and hopeless at least once per week.
Societal and cultural discrimination
People who are transgender are more likely to experience discrimination throughout their daily lives. In the Trevor Project survey, 71% of transgender youth said they experienced discrimination based on their gender identity. When people experience discrimination, it can cause mental health disorders or make them worse.
There are also an increasing number of anti-trans regulations and proposed legislation focused on preventing transgender people from embracing their gender identities. This is a cause of worry – 93% of transgender youth in the Trevor Project survey said that they are concerned that transgender people will be denied access to gender-affirming medical care due to state or local laws.
Challenges at school or work
While there are some laws that offer protection in the workplace or at school, they aren’t aways enough. People who are transgender commonly experience microaggressions such as being called the incorrect name and pronouns, and challenges in using the bathroom that matches their gender identity.
Because hostile behaviors still exist even in these protected spaces, it can be difficult for people who are trans to feel comfortable and thrive. Only about 50% of trans youth in the Trevor Project survey said that their school was a gender-affirming space.
Other health problems
Physical health is tied with mental health, but many trans people don’t get the care they need to stay healthy. About 20% of trans people say they have been denied care or have been treated poorly from doctors who don’t support gender-affirming care. Many others are concerned that they’ll have a poor health care experience.
In Minnesota, 29% of trans people avoid going to the doctor because they feel they won’t be respected or accepted, according to the Rainbow Health survey. As a result, people who are transgender may not get preventive care such as breast cancer screenings to help them stay healthy.
There’s a strong link between financial security and mental health. If someone doesn’t know where they’ll find their next meal or where they’ll sleep at night, they’re more likely to feel anxious and stressed. Unfortunately, people who are transgender are often less financially secure than others.
Over one-third of transgender people in Minnesota have run out of food before they had the money to buy more, and 43% have experienced homelessness, according to the survey from Rainbow Health.
Trans people are more likely to be uninsured than the general population. According to the United States Census Bureau, 8.6% of the general population did not have medical insurance in 2020. In Minnesota, the percentage of uninsured trans people is about twice as high at 17.7%, according to the Rainbow Health survey.
But just having insurance isn’t always enough. The Rainbow Health survey notes that within the last year 40% of trans people in Minnesota skipped going to the doctor because of the cost.
Gender-affirming treatments such as puberty-blocking medicines, hormone replacement therapy and surgery aren’t always covered by insurance companies. But if a trans person can’t get the medical care they need to affirm their gender, they may continue to have anxiety and depression caused by gender dysphoria. That’s why HealthPartners works hard to ensure that important gender-affirming care is covered under our health plans.
Transphobia and transgender hate
In the Rainbow Health survey, 70% of Minnesotans who are transgender said they’ve experienced verbal abuse or harassment in the last 12 months because of their gender identity or sexual orientation. And more than one-third have been physically attacked or threatened.
The Trevor Project survey share similar results for transgender youth from across the country – 37% say they have been physically threatened or harmed because of their gender identity.
The risk of violence is especially distressing for trans women or girls. In the Trevor Project survey, 55% of trans girls said they’ve been physically threatened or harmed. And trans women of color are the most common targets of fatal violence against the transgender and gender nonconforming community.
The hate, negativity and violence focused on people who are transgender can make trans people feel like they’re not valuable, causing depression and suicidal thoughts. They may even fear for their personal safety or life – causing high levels of anxiety.
What you can do about mental health in the trans community
The high rates of mental health concerns in the trans community – and the reasons for them – are heartbreaking. But you can help makes things better for people who are transgender simply by being welcoming, supportive and respectful.
In fact, in the Trevor Project survey, youth were less than half as likely to try suicide when they were in a community that was very accepting of their gender identity compared to one that was somewhat unaccepting. Here are a few things you can do to support the mental health of a person who is transgender:
Support their gender identity
Proper use of a person’s chosen name and pronouns can be one of the best ways to support people who are transgender. Ask what their pronouns are and use them. And if you hear someone else use the wrong name or gender, politely correct their error.
Ask about their mental health
Mental health concerns don’t go away if you ignore them. Respectfully asking if someone is considering suicide can potentially save their life. If they don’t want to talk to you, help them find someone else to talk to. Supportive, free options include:
- The Trevor Project – The Trevor Project is the world’s largest suicide prevention and crisis intervention organization for LGBTQ young people. Youth can reach a counselor 24/7 by calling 1-866-488-7386, texting “START” to 678-678, or chatting from a computer.
- 988 Suicide & Crisis Lifeline – Anyone in suicidal crisis or emotional distress can dial 988 at any time, day or night, for free and confidential support.
- Trans Lifeline – This hotline, run by people who are transgender, provides support for trans and questioning people. To get support for both crisis and noncrisis situations, call 1-877-565-8860.
Help them get therapy
Mental health care can be invaluable in helping to manage anxiety, depression and other mental health concerns. But unfortunately, not everyone gets the therapy they need.
Among the youth in the Trevor Project survey, 82% wanted mental health care in the last year. But only 40% of those who wanted mental health care, got it.
Most of the time, the issue wasn’t that parents or caregivers refused to get their child therapy. The bigger issue was that kids were concerned about getting permission and simply didn’t ask.
If you have concerns about your child’s mental health, don’t wait for them to ask about therapy. Let them know that most people can benefit from therapy and see if they’re interested. Then look for a therapist who specializes in gender-affirming care or has experience supporting people with different gender identities – you should be able to find this information by looking at a therapist’s bio on their website.
Connect them with gender-affirming care
Getting respectful health care isn’t always easy for people who are transgender. Even going to the clinic or hospital can be a stressor if a trans person is required to check in with their legal name or sees the wrong gender on a hospital wristband.
HealthPartners is working hard to change this. We’re devoted to providing a gender-affirming experience from start to finish. Our gender medicine experts have extensive experience working with patients of all gender identities. HealthPartners has also changed our systems and processes so people can update their patient account with preferred name, gender identity, sex assigned at birth and sexual orientation. We also have removed legal sex from wristbands and documents related to patient visits.
Understand transgender issues
People who are transgender don’t always have the same rights as gender-conforming individuals – for example, when trying to secure housing, public accommodations, health care and using bathrooms that match their gender.
Understanding and speaking out against discrimination and bias, can be a way to show support for people who are transgender. Learn more about transgender issues:
- The American Civil Liberties Union (ACLU)
- National Center for Transgender Equality
- Human Rights Campaign
Get help for mental health concerns
Mental health should be a priority for everyone. If someone is struggling, it’s important they get the care and support they need.
Finding the right therapist can help people who are transgender work through mental health concerns caused by gender dysphoria, discrimination, loneliness, trauma and other factors. If appropriate, a mental health professional can also help a person get medications to manage mental health concerns.
But in crisis situations, trans people or their loved ones should call 988 for the Suicide &Crisis Lifeline or reach out to a counselor at the Trevor Project.