Release time: 2020-07-17 17:22

Psychological Distress Among Transgender Individuals

Social support and transitioning now rather than later are critical.

Transgender individuals tend to experience relatively high levels of poor mental health, research indicates. Recent studies suggest that involvement in trans activism may be related to greater, not lesser, degrees of distress. Other factors, such as undergoing hormonal and surgical procedures, are associated with less distress.

Transgender and gender nonbinary individuals constitute “a minority population whose gender identity differs significantly from the sex they were assigned at birth” (Institute of Medicine). The overwhelming majority of research during the past decade with transmen, transwomen, nonbinary, genderqueer, and gender-nonconforming individuals documents their “disproportionate burden of negative mental health outcomes,” on nearly all measures of psychological and social distress, such as gender dysphoria, depression, and suicidality. How to alleviate or moderate these high levels of psychological distress has been a focus of considerable research.

What Factors Are Related to Less Distress?

With a sample of 330 trans individuals, Pablo Valente and colleagues reported, “More than one-third of participants scored above the 90th percentile of community norms in the U.S. with respect to anxiety and depressive symptoms.” They, and nearly all previous researchers, attribute these negative emotional states to elevated levels of gender-related discrimination and stigma—although most researchers merely document that distress and harassment are associated with each other rather than demonstrating that one causes the other.

Valente and colleagues explored the potential effects of family support, feeling connected to the transgender community, gender literacy (ability to identify how societal gender norms affect and oppress), and transgender activism (advocating on behalf of the transgender community). As expected, family support (but not connection with a trans community) was associated with less distress; however, counter to expectations, gender literacy and transgender activism were associated with more, rather than less, psychological distress. Their explanation was as follows: “Individuals with high gender literacy and involvement in activism may be more likely to be vigilant to or targeted by prejudice and discrimination” and thus suffer because of their involvement in collective action. The result may be a greater exposure to high levels of stigmatization that can lead to fatigue and burnout, which in turn could increase internalized transphobia. Or, turning around the equation, trans individuals who already feel psychologically distressed may be more prone to involve themselves in trans activism as a coping mechanism. 

The authors concluded, “While our study lends support [but not proof] to the hypothesis that discrimination negatively impacts mental health and that social support is generally beneficial, we did not find support for the hypotheses that … gender literacy and political activism immediately instill resilience.”

Longer Time Since Transitioning

Psychologist Jennifer Staples and colleagues took a different route to investigate psychological distress, with a sample of over 300 transgender and gender-nonconforming individuals—two-thirds of whom were assigned female at birth. On average, they were 28 years old, 6 years younger than the Valente sample, and were not exclusively from three urban areas as Valente’s sample was, but rather from throughout the United States. Recruitment was solicited with the help of social media advertisements, trans-related organizations, and snowball sampling from other participants. When given the choice of 14 gender identities, the most commonly selected were transman, transwoman, and genderqueer/gender-nonconforming.

Consistent with previous research, those who had hormone therapy or gender-affirmation surgery were more satisfied with their body than were those who wanted these interventions but had not had them. The more novel finding was to highlight the significance of the amount of time that had passed since beginning gender-affirming transition, which was related to higher levels of body satisfaction. Many of the non-transitioned individuals wanted hormonal or surgical interventions but confronted barriers such as “finances, lack of service availability or information about how to acquire care, and fears or worries.” Their road to body satisfaction and, very likely, to self-acceptance and mental health was thus thwarted. Most will likely experience an improved psychological state over time after they begin the process of living their authentic life.

Bottom Line

These two studies are valuable in their own right, although other critical transgender issues remain under-researched, perhaps because they are highly controversial. We need more information about the role of pubertal blockers for pre-teen children (medical, psychological, and ethical concerns); the prevalence and rationale of “desisters” (also called “detransitioners”) who decide not to persist in their gender transition; and the ideal age and conditions prior to undergoing hormonal or surgical procedures. These two studies provide additional support for the importance of making the transition for many individuals and he idea that with time, the individual will tend to feel better undergoing the transition—after, of course, they are certain they want to transition. Is the age of the individual critical here? Are their sexual and romantic orientations of relevance? Is their mental health status at the outset of the transition or afterward of critical importance?

Ritch C. Savin-Williams, Ph.D., is Director of the Sex and Gender Lab at Cornell University.

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