An Introduction to Transgender Well-Being

Transgender and gender diverse (TGD) individuals (individuals whose gender identity is not aligned with their assigned sex at birth) are a historically marginalized group. Although TGD identities have been recorded throughout history, TGD individuals have experienced increased rates of discrimination in medical settings, harassment in public spaces, and victimization and non-affirmation in schools. While there has not been a good resource to capture the exact number of individuals who identify as TGD, estimates have been close to 1 percent of the general population. As we do not currently have nationwide surveys that include both assigned sex and gender identity, we cannot fully estimate prevalence. 

It is important to note that every person’s gender journey is unique. While some people might transition socially (using a different name, pronouns, or outward expression of gender), others might need hormonal intervention (hormone blockers, estrogen, testosterone), and some may also need surgical interventions (e.g., chest masculinization/breast augmentation, genital affirming surgeries, tracheal shaving) to align their body with their internal sense of self. Some gender journeys appear to be straightforward, while others are more circuitous. Some individuals identify on the binary (transgender female or male) while others identify as nonbinary (e.g., genderqueer, gender fluid, gender-flexible). 

Unfortunately, transgender and gender diverse individuals experience mental health challenges at higher rates that their cisgender peers (individuals whose assigned sex at birth is congruent with their gender identity). TGD individuals are more likely to experience depression and/or anxiety, engage in self-injurious behaviors and/or problematic eating behaviors (to either stop monthly cycles or alter the shape of their bodies), and are nine times more likely to attempt suicide than their cisgender peers. Why are TGD folks at a higher risk for these issues? 

One framework to understand this is the Gender Minority Stress Model, which suggests that external factors such as discrimination, non-affirmation of one’s identity, violence, and rejection can all have a negative impact on a person’s mental and physical health. Furthermore, these external factors can also influence internal thoughts and behaviors. Internal factors such as internalized transphobia, negative expectations about the future (e.g., “I will never be accepted/loved, get a job, or the care I need”) and a concealment of one’s identity are amplified by the noise individuals hear from the external world, and also impact mental and physical health. Therefore, as TGD individuals are being discriminated against in public spaces, not provided the medical care they need, and are bullied in schools (or by their caregivers), they relatedly may suffer from co-occurring mental health issues at a higher rate than their cisgender peers. Importantly, individuals who have multiple marginalized identities (e.g., BIPOC, neurodiverse, LGB, differently-abled individuals) tend to be discriminated against and victimized at higher rates. 

On the other hand, research suggests that youth who are supported in their identities have similar levels of depression and slightly higher (and still subclinical!) levels of anxiety than their siblings and aged matched peers. Similarly, individuals who are accepted and supported by their caregivers are less likely to use substances in a harmful manner, are less likely to engage in risky sexual behavior and are less likely to attempt suicide. When individuals are able to use their chosen name and pronouns, they are less likely to contemplate suicide. And when schools have non-discrimination policies openly protecting TGD students, have multiple staff members who are allies and have a school-based club supporting all identities and orientations, youth feel safer, are more likely to successfully complete school, and are more likely to pursue college. If TGD individuals are able to find pride in themselves and connect with other individuals in the community, these are protective factors that can mitigate some of the external and internal stressors that are associated with negative health outcomes. 

Importantly, there are multiple resources that people can utilize to help support transgender and gender diverse individuals. If families of young children want to learn more about how to support their child, they can follow the research at the TransYouth Project, they can access free information from the Family Acceptance Project or they can find a local chapter of PFLAG to meet other families of TGD youth. Medical providers who wish to have a more inclusive space can utilize free downloads that teach families about how to support LGBTQ youth, how to make bathrooms more inclusive or how to create a welcoming environment in medical settings (including inpatient settings). Providers can also access free trainings to bolster their skills in working with TGD folks. Individuals working in a school setting can learn more about their school climate, download free resources on how to make schools more inclusive, how to integrate more inclusive books into their library and how to teach a more inclusive health class. If you are struggling with how religion can be supportive of TGD identities, please examine the resources on Gender Spectrum. 

Transgender and gender diverse individuals need to know that there are people out there who support and believe in them. 

If you are struggling with thoughts of suicide or self-harm, please reach out to supports through the Trevor Project or Trans Lifeline. If you need access to legal resources, please have a look at the National Center for Transgender Equality,  the Sylvia Rivera Law Project, GLAD, Lambda Legal or Transgender Legal Defense and Education Fund. If you need to find a mental health provider to support you, you can look into Queer and Trans therapist of Color Network or reach out to an academic medical center that provides transgender healthcare to see if they have a list of trans-competent providers. To find safe bathrooms when you are out and about check out Refuge Restrooms. Additionally, here is a list of resources for BIPOC LBGTQIA+ folks. 

Transgender and gender diverse individuals have been documented throughout history. They deserve the right to competent, respectful and affordable medical care, safe public spaces, affirming hospitals and safe schools. Cisgender allies can educate themselves on the barriers transgender individuals face in multiple areas and work together to make the spaces we inhabit more welcoming.

About the Author

Christy L. Olezeski, PhD is an Associate Professor in the Departments of Psychiatry, Pediatrics and Child Study at Yale School of Medicine. Dr. Olezeski is also the Director and co-founder of the Yale Pediatric Gender Program, an interdisciplinary team providing holistic care to transgender and nonbinary individuals 3–25 and their families. Dr. Olezeski is also a Public Voices Fellow with the Op-Ed Project. 

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