Highlights
- Transgender studies show that transgender (trans) youth and adults have higher rates of suicidality and self-harm than their cisgender peers.
- Barriers to care, social stigma, discrimination, and harassment contribute to poor mental health outcomes for trans individuals.
- Gender-affirming care is a life-saving resource for both transgender youth and adults.
- Social support is important to improving mental health outcomes for the LGBTQ+ community.
- Learn more about gender identity and supporting gender-diverse loved ones with the resources available at eDrugstore.com.
Members of the LGBTQ+ community often face stigma, discrimination, and harassment that places them at risk for developing mental health conditions. Transgender (trans) and other gender diverse people have the highest rates of self-harm within the LGBTQ+ community. Supporting gender diversity is essential to improving mental health outcomes for trans youth and adults.
Mental Health in the Transgender Community
An estimated one in five adults currently lives with a mental health condition. Transgender adults are close to four times as likely to have a mental health condition as their cisgender counterparts. This is an alarming statistic, considering several high-quality studies confirm this disparity between cisgender and transgender mental health.
Data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) revealed that three out of five transgender participants reported having experienced poor mental health at least one day in the past month.
The U.S. Transgender Survey showed that 39 percent of transgender participants reported serious psychological distress, compared to only 5 percent of cisgender participants.
Anxiety and Depression
People who are transgender experience high rates of anxiety and depression compared to the general population. This is consistent for trans youth and adults alike.
A recent study revealed that trans college students were twice as likely to be diagnosed with anxiety and depressive disorders than their fellow cis students.
Similar results have also been found in youth studies. For example, more than two out of three trans and nonbinary youth reported symptoms of major depressive disorder during the 2019 Trevor Project National Survey. Additional research suggests that transgender youth are twice as likely to experience depressive symptoms, including suicidality, when compared to cisgender lesbian, gay, bisexual, and queer youth.
Risk of depression seems to increase even more in transgender people who don’t have access to gender-affirming care. For example, a recent large-scale study showed that transgender participants who hadn’t received clinical care had a nearly four-fold increased risk of depressive disorder.
Self-Harm and Suicidality
Both transgender youth and adults are at high risk for suicidality and self-harm.
A recent population-level report demonstrated that 81 percent of transgender respondents had suicidal ideation (had thought of attempting suicide) at some point in their lives. More than half (56 percent) of transgender respondents reported engaging in non-suicidal self-harm.
Additional research shows that nearly 40 percent of transgender adults report having attempted suicide in their lifetime, compared with only five percent of the general population.
Data from the 2019 Trevor Project National Survey suggests that more than half of transgender and non-binary youth reported having seriously considered suicide.
Recent research suggests that risk for suicidal thoughts and behaviors is even higher in transgender individuals who hold multiple marginalized identities. For example, a recent study aimed to assess the impact of race, ethnicity, education, and income on mental health outcomes of transgender adults. The author commented that transgender adults who held more than one marginalized identity reported the highest rates of suicidal behavior.
Risk Factors
There are many factors that place trans people at risk for suicidal ideation and self-harm. Researchers and clinicians alike hypothesize that risk is largely tied to social factors.
Minority Stress
The minority stress model is a well-researched theory that suggests minority groups face unique and harmful stressors in society that negatively impact their health and well-being. Members of the LGBTQ+ community often experience minority stress related to their gender or sexual orientation.
Transgender youth and adults often experience minority stress in the form of discrimination, harassment, rejection, and internalized cissexism. Research shows that these stressors can contribute to severe anxiety in trans individuals. Additional research suggests that transgender people who experience multiple social stressors are at a higher risk for mental health problems.
Harassment and Discrimination
Harassment and discrimination can have a devastating impact on a person’s mental health and well-being. Transgender people are more likely to experience discrimination and harassment than their cisgender peers.
This unfair treatment is often rooted in transphobia. Transphobia is a term used to describe negative attitudes, feelings, or actions towards transgender people. This can include discrimination against trans people in seeking employment, housing, healthcare, or other services.
Data from the TransPop survey reflects the consistent and severe discrimination many trans people face in their daily lives. According to the survey, transgender respondents experienced the following forms of discrimination within the past year:
- More than 27 percent reported that people acted as if they were afraid of them
- Nearly 36 percent reported that they were called names or insulted
- 28 percent reported that they were threatened or harassed
Violence Against Transgender People
The discrimination and harassment transgender people face often escalates to violence. Transgender people are at a greater risk for being threatened with violence, physically assaulted, sexually assaulted, and murdered. Experts agree that violence against trans people contributes to minority stress within the transgender community.
According to data from the National Crime Victimization Survey, transgender people over the age 16 were victimized over four times more often than their cisgender counterparts between 2017-2018. The authors noted that experiences of victimization are linked to poor well-being, suicidal thoughts, and suicidal behaviors.
A 2022 brief from the U.S. Department of Justice analyzed crime data by gender identity from 2017-2020. They reported that transgender people experienced violent crime at more than 2.5 times the rate of cisgender people.
These findings align with more recent data from the TransPop Survey. According to the survey, nearly 48 percent of respondents had been hit, beaten, physically attacked, or sexually assaulted since turning 18. More than 61 percent of respondents had been threatened with violence.
Lack of Support
The process of coming out, or transitioning, can be a harrowing experience for any transgender person, regardless of their age. Many trans people report facing rejection from loved ones. Lack of support at home, within social groups, or within school or workplaces can have a devastating impact on your mental health.
Data from the 2022 Trevor Project National Survey showed that only 32 percent of transgender youth felt their home to be a gender-affirming space. Only 51 percent of transgender youth felt their school to be a gender-affirming space.
Social rejection places transgender people at greater risk for self-harm and suicidal behavior. The U.S. Transgender Survey revealed that adults whose spouses, partners, children, or religious communities rejected their transgender identity had higher prevalance of lifetime and past-year suicide attempts.
Barriers to Care
There are many barriers to accessing care within the United States healthcare system. This is especially true for trans and gender non-conforming people. Trans people face unique barriers in seeking basic health care and gender-affirming care alike.
This trend holds for youth and adults. According to the Trevor Project Survey, three in five transgender youth who wanted mental health care in the past year were unable to access it. According to recent data from the TransPop survey, 33 percent of transgender adults reported postponing care due to the cost.
Some of the healthcare system’s most pervasive barriers to gender-affirming care include:
- Lack of insurance or inadequate coverage
- Insurance denials for gender-affirming care
- Inadequate healthcare provider training
- Provider shortages or service shortages
- Provider discrimination and harassment
Even when a trans person has access to insurance coverage and services within their area, they may not be able to find a provider who treats them with respect. Trans people are also at higher risk for facing poverty, eviction, homelessness, and transportation barriers. These problems create additional barriers to seeking and receiving care.
Promoting Mental Health for the Transgender Community
Trans people face substantial system-level, social, and interpersonal barriers to individual flourishing. Having a strong support system goes a long way to overcoming these challenges. Fortunately, we can all play a part in showing up for the transgender community.
Amit Paley, CEO and Executive Director of The Trevor Project, states, “The fact that very simple things — like support from family and friends, seeing LGBTQ representation in media, and having your gender expression and pronouns respected — can have such a positive impact on the mental health of an LGBTQ young person is inspiring, and it should command more attention in conversations around suicide prevention and public debates around LGBTQ inclusion.”
Social Support and Acceptance
Research suggests that social support and acceptance can be a protective factor against self-harm and suicidal behaviors for transgender youth and adults.
Data from the Trevor Project Survey demonstrate that transgender youth who found their school to be gender affirming reported lower rates of attempting suicide. Transgender youth living in a gender-affirming home reported lower rates of attempting suicide than youth who did not.
This aligns with data from other national surveys of transgender and gender nonconforming people. Data from the U.S. Transgender Survey revealed a lower prevalance of past-year suicide attempts among:
- Participants who reported their families were supportive
- Youth with families that used their chosen name
- Adults with supportive classmates or coworkers
Access to Gender-Affirming Healthcare
Access to gender-affirming care is recognized as a life-saving resource for trans youth and adults alike. Gender-affirming care looks different for everyone.
Gender-affirming health care can encompass any of the following:
- Therapy and mental health care
- Hormone therapy
- Puberty blockers
- Medical procedures
- Surgical procedures
Recent research suggests that gender-affirming care supports improved mental health outcomes in transgender and gender-nonconforming youth and young adults. Trans participants who received gender-affirming care from a multidisciplinary gender clinic had lower odds of depression and suicidality over 12 months. Participants who received puberty blockers or gender-affirming hormones had 60 percent lower odds of depression and 73 percent lower odds of self-harm or suicidal thoughts.
A study published in JAMA Surgery suggests that gender-affirming surgery supports improved mental health outcomes for transgender adults. Researchers found that gender-affirming surgery was associated with a 35% reduction of past-year smoking, a 42% reduction in experiencing past-month psychological distress, and a 44% reduction in past-year suicidal ideation. These findings build on existing scientific literature supporting gender-affirming care for trans individuals.
Legal Affirmation and Protections
Transgender youth and adults face threats to their legal rights to access gender-affirming care, learn and work in gender-affirming environments, and participate in activities aligned with their gender identity.
Studies show that even seemingly simple legal affirmation can have a positive impact on mental health outcomes for transgender people. For example, one study found that the ability to easily change your gender marker and name on government identification was associated with lower reports of depression, anxiety, psychiatric distress, and negative responses to gender-based mistreatment.
Distress related to these threats was reflected within results from the Trevor Project Survey. The survey found that 93 percent of transgender and nonbinary youth were worried about transgender people being denied gender-affirming care due to state or local laws. At least 91 percent of trans youth reported worry over being denied access to the bathroom due to state or local laws.
Resources and Crisis Lines
There are several national organizations that provide resources to the LGBTQ+ community and their loved ones. Transgender people can also tap into state or local organizations to find resources closer to home. A counselor can help you walk through the best resources for your needs during transition counseling.
Crisis prevention lines are an essential resource for those who need instant support.
- For the transgender community. In the event of a crisis, trans people can also access support through TransLifeline.
- For LGTQ+ youth. The Trevor Project hosts the only accredited, 24/7, suicide prevention helpline for LGBTQ+ youth.
- For everyone. If you or a loved one needs immediate support for suicidal thoughts, call 988 to reach the National Suicide Prevention Lifeline.
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Shelby is a public health professional with research and field experience in sexual and reproductive health. She holds a Master of Public Health (MPH) and is a Certified Health Education Specialist (CHES).
