Gender Identity and Transgender Health

Gender describes how we perceive ourselves in relation to the traditional gender binary, male and female. For some people, gender identity corresponds with the sex we were born with, or our physical, biological sex at birth, but sometimes it does not.

Transgender is an umbrella term that describes a diverse group of people—including trans men, trans women, genderqueer individuals, and others whose gender expression or identity differs from societal expectations of how they should look, act, or identify based on their biological sex. 

The transgender community has increased significantly in recent years. This increase may be due, in part, to increasing acceptance surrounding gender identity issues, which makes transgender adults and adolescents feel more comfortable with coming out.

Transgender Health Disparities

Transgender people experience the same challenges as cisgender and binary people and may experience psychological issues that are not directly related to their gender identity. In an important step toward recognizing transgender health, the World Health Organization recently removed ‘gender identity disorder’ from its mental disorder diagnostic manual. However, gender dysphoria is still a widely accepted diagnosis. Approximately .5–1.3% of people experience gender dysphoria. Gender dysphoria is defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as the psychological distress an individual experiences when their gender identity differs from their biological sex. Gender dysphoria is a unique challenge among trans individuals but is not experienced by all trans people.

Overall, transgender people face significantly higher risks of psychological challenges, such as anxiety, depression, and suicide attempts, than cisgender people. Additionally, transgender people face more overall health risks, including greater tobacco use, a higher risk for HIV infection among trans women of color, and a lower likelihood of positive cancer screenings among trans men.

In a systematic review on healthcare, researchers found that transgender people, intersex people, and gender non-binary adults face greater barriers to healthcare services in the United States.In part, this increased risk and lack of access to health care may be due to stigma, stereotypes, discrimination, and human rights issues faced by transgender people. 

Common Trans Mental Health Challenges

Although psychological challenges vary between individuals, the following difficulties may contribute to the increased rates of psychological concerns among transgender youth and adults:

• Questioning gender identity: For a transgender person, questioning and exploring gender identity can create significant distress. Redefining gender identity based on an internal sense of what feels “right” and “wrong” can lead to dramatic shifts in self-perception.

• Coming out: It’s normal for a transgender person to fear rejection when coming out to friends, family members, and loved ones. Although coming out can be a liberating experience, many people worry about how others will react.

• Affirmation: Transgender people may take various steps in the journey toward expression. Some examples of affirmation or transitioning include going by different pronouns, expressing femininity, masculinity, or androgyny by trying a new hairstyle and changing gender on a driver’s license or birth certificate. Other examples require consultation with a physician, including seeking medical care for hormone therapy or surgery to alter secondary sex characteristics (physical characteristics).

• Relationship challenges: Close relationships can be strained, and those with different gender identities can experience stress due to traditional gender roles and cultural expectations. 

• Gender development: In transgender youth and adolescents, puberty can be a stressful experience. Trans youth may feel especially anxious when their secondary sex characteristics—such as breasts and body hair—don’t match their gender identity. Additionally, the increased presence of the sex hormones testosterone and estrogen can lead to further distress.

• Discrimination: A person’s gender identity or sexual orientation can lead to discrimination. Some victims of discrimination experience bullying, harassment, or even violence due to their transgender identity.

What should you do if you’re experiencing mental health challenges?

Whether you’re experiencing challenges related to your transgender identity or having unrelated concerns, it’s important to remember that help is available. Some helpful resources for trans and gender diverse individuals include:

• Therapy: If you’re experiencing significant distress, working with a qualified therapist who has experience in gender identity and trans issues can help.

• Support groups: Many communities offer local support groups and resources, which can be found through the LGBTQ National Help Center and the National Center for Transgender Equality. Additionally, during COVID-19, many online support communities, such as the Lesbian, Gay, Bisexual & Transgender Community Center and Gays and Lesbians Living in a Transgender Society, Inc., are offering support group access to help trans and LGBTQ people stay connected and foster conversations with like-minded people.

• Helplines: If you identify as trans, the Trans Lifeline (1-877-565-8860) offers 24/7 help from transgender staff. Meanwhile, for transgender youth, adolescents, and young adults, the Youth Talkline (1-800-86-YOUTH) offers peer support on LGBTQ and trans issues. If you’re having suicidal thoughts or need immediate support, help is always available through the National Suicide Prevention Lifeline (1-800-273-8255).

• Medical care: Because homophobia and transphobia are still issues in health care, it’s important to find a competent health care provider to provide informed medical care. If you’re unsure where to start, consider asking your therapist for a referral to a healthcare provider. Whether you’re interested in learning more about hormones and the gender affirmation process, undergoing medical procedures—such as a vaginoplasty—to change your external genitalia, or need treatment for a medical condition or disability, your healthcare provider can review your medical record and implement the best practices moving forward.

If you’re planning to cover healthcare services or therapy using your insurance company, it’s essential to keep in mind that many health insurance plans, including those part of the Affordable Care Act, exclude services related to gender change and hormone replacement therapy. On the other hand, Medicare covers medically necessary hormone therapy for trans people. 

Therapy for Gender Identity and Transgender Health

Whether you’re struggling with gender identity questions, sexual orientation issues, or other mental health concerns, it’s important to make sure your therapist has extensive training in trans and LGBT health-related issues. Your therapist should understand and recognize the difference between a person’s sex, a person’s gender, and a person’s sexual orientation, and that a wide range of gender identities are possible.

There have been recent strides in psychology and therapy related to “Queering Psychology“, but there’s not currently an official credentialing system for therapists and psychologists who specialize in trans-related issues. However, it can be helpful to search for therapists, psychologists, social workers, and counselors who are members of recognized trans/LGBTQIA professional organizations, such as the World Professional Association for Transgender Health and the Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling.

To find the right therapist, reach out to a mental health professional through WithTherapy. We’ll connect you to a social worker, counselor, psychologist, or mental health care professional you feel comfortable with, regardless of your personal background and requirements. One of the licensed therapists on the WithTherapy platform will help you navigate any issues related to gender expression and identity to take control of your mental well-being and improve your quality of life.

Find a Therapist to Help With Gender Identity and Transgender Health