Transgender Mental Health Issues: The Challenges of a Binary World

Adam was assigned a female gender at birth, but from an early age he did not feel comfortable identifying as female. Like many transgender people who struggle with mental health issues, the pressure of society’s gender norms caused stress and confusion.

Coming out as transgender is a challenge for anyone, but it was especially difficult for Adam. He grew up in a small, close knit town with one high school. His uncle was also his landlord, an example of how his environment could be suffocating at times.

At the age of 15, Adam came out as transgender and began identifying as a man. With the exception of his father, no one in his family or community supported him. Peers mercilessly bullied and ridiculed him until he dropped out of high school. Then the final blow hit: Because of his decision, his uncle, the landlord, refused to provide him a residence.

Adam and his father left town and headed to Los Angeles to start a new life. He had researched a Los Angeles-based youth center that supported transgender people. The staff at the youth center connected him with a therapist, and the healing began.

Unfortunately Adam’s story only speaks to a few of the mental health issues transgender people tend to endure. Here are some enlightening statistics that allude to other issues:

• According to a survey of 27,715 respondents from all fifty states, 10% of transgender people who are out experience violence from a family member
• People who are out or perceived as transgender in school environments are more likely to be victims of verbal harassment (54% of survey respondents), physical attacks (24%), and sexual assault (13%)
• 39% of respondents experienced serious psychological distress
• 40% had attempted suicide

This article will help you learn more about transgender mental health issues and become an advocate for the trans community. If you identify as transgender, you might find some useful information and resources.

Gender Dysphoria

Many transgender people experience gender dysphoria, a conflict between their biological or assigned gender and the gender they identify with. Kai, a transgender man, experienced emotionally painful gender dysphoria when he was using testosterone to better transition but still had his period every month.

“It was a monthly reminder of a past part of myself I have walked away from,” he said. “After all this work to look and feel happy in my own body, it felt as though my body was betraying me.”

Dr. Kristie Overstreet, who specializes in working with transgender clients, offered the example of a transgender man who feels uncomfortable with his high-pitched voice. He wishes he had a lower-pitched voice to make it easier to “pass” as a man.

Gender dysphoria can cause severe anxiety and depression. Transgender people who suffer from it may have anxiety about whether they will ever feel comfortable in their bodies. Perceived failures to transition may lead to depression.

Workplace Discrimination and High Unemployment

When transgender people are out about their orientation — or look or behave in a way where people can discern that part of their identity — they are more likely to be unemployed or underemployed. It is also difficult for them to keep a job for as long as cisgender people. Employers are likely to discriminate against transgender employees by making excuses for firing them or denying a promotion.

Likely related to issues of employment, about 30% of respondents in the aforementioned 2015 survey reported experiencing homelessness and extreme poverty. During the time of the survey, the unemployment rate for transgender people was three times the national average.

Bianca Palmisano, who trains behavioral and medical health professionals to treat LGBTQ patients, has worked with transgender clients who have been concerned for their safety in the workplace. To avoid persecution, they have dressed in ways that will not draw attention but also do not align with their transgender identity. They have also avoided being in the bathroom with co-workers by drinking less liquids at work and using off-site bathrooms.

Media and Legal Vilification Regarding Bathroom Use

There have been many TV shows and films that feature transgender characters who are predatory, psychotic, or unable to function. These portrayals have implied transgender people are inherently disturbed or doomed to be nothing but victims.

Publications and news organizations have portrayed transgender people as “perverts” who are trying to harass cisgender people in bathrooms.

“The media is pretending trans men don’t exist and trans women are predators,” Palmisano said.

Despite several surveys and studies showing transgender people are more likely to be victims of violence — not perpetrators — when using restrooms, this false narrative has continued. Lawmakers in many states have recently proposed legislation to limit transgender rights regarding the use of public bathrooms.

Discrimination from Behavioral and Medical Health Professionals

Since the idea of identifying as transgender emerged, many doctors, therapists, and psychiatrists have tried to pathologize it rather than acknowledging it as an identity. Because of this discrimination, roughly 33% of transgender people have negative experiences with health professionals.

When J Mase III, a trans performance poet and founder of awQward, consulted a psychiatrist to be approved to donate a kidney to a friend, the psychiatrist assumed something had traumatized him and caused his transgender identity. He saw being transgender as a mental health problem, not an identity someone could be happy about.

Understanding What It Means to be Transgender

Now that gay and lesbian people have gained more rights, advocates have turned the spotlight toward the transgender community.

“The trans community is not so invisible anymore,” said John T. Nash, who spent many years marketing to the LGBTQ community and now co-hosts The Focus Group.

This may be a positive step, but it has also revealed how uneducated most Americans are on what it means to be transgender and how to interact with transgender people.

“How do you navigate [transgender issues] in a binary society?” Nash asked. “Think of the dissonance of having to describe who you are on multiple levels.”

For example, many cisgender people do not know what pronouns to use when referring to transgender people. Mase recommended being safe by starting with “they” pronouns until you know which pronoun the transgender person prefers.

There are also cisgender people who still use the term “transexual” and confuse it with being transgender. “Transexual” is actually an outdated term some people find offensive, according to Palmisano.

The many identities within the umbrella of the transgender experience can be even more difficult for cisgender people to grasp. Here are a few examples:

• Genderqueer: not subscribing to conventional gender distinctions
• Gender nonconforming: not following ideas about how they look look or act based on the gender they were assigned at birth
• Gender non-binary: some use this term as a synonym for genderqueer and vice versa and prefer it because of the history of heterosexual, cisgender people using “queer” as an insult to put down LGBTQ people

Because most of the cisgender people around them are so far from understanding transgender issues, it can be hard for transgender people to feel accepted and comfortable. This issue most likely contributes to feelings of depression and anxiety.

Lack of Representation in the LGBTQ Community

Unfortunately transgender people face discrimination within the LGBTQ community as well. There are many LGBTQ people who refuse to acknowledge the existence of transgender people or think they are “gross,” Mase said. The acronym suggests a cohesion that does not actually exist.

Both Mase and Kai noted that white cisgender men, particularly gay men, tend to lead most LGBTQ organizations or communities, even ones that focus on transgender issues. This lack of trans leadership makes it difficult for transgender people — especially those of color — to feel empowered. Transgender people of color need more support and representation, especially because they are more likely to be victims of violence and discrimination compared to white transgender people.

Resources for Supporting Transgender Mental Health

If you want to become an advocate for the transgender community, support efforts to improve transgender mental health or look for mental health treatment options, the first step is becoming educated. Here are some resources to get you started:

• Philadelphia Trans Health Conference
• awQward (writing and performance camps for trans people of color, education on trans issues)
• Transfaith
• Trans Sistas of Color Project

• The Family Partnership — Transgender Mental Health
• The National Alliance on Mental Illness
• The Association for LGBT Issues in Counseling
• The PRIDE Institute — Transgender Support Group
• QSPACES Health — A Service for Finding a LGBTQ-Friendly Doctor

If you identify as transgender or are in the process of discovering your identity, some of the issues in this piece might speak to you. Consider connecting with a LGBTQ-affirmative therapist who can help you work through them.