Gender Identity & Transgender Mental Health

Gender is a way of describing how we think about ourselves in relation to socially constructed ‘male’ and ‘female’ behaviors and roles. Sometimes our gender identity corresponds with the sex we were born with (that is, our physical, biological sex at birth), but sometimes it does not.

Transgender people identify with a gender that is different from their sex at birth.

Recent research shows that around 0.5 to 1.3% of people identify as transgender and rates are increasing. This may in part be due to the increasing awareness and acceptance of gender identity issues, which means people feel more comfortable coming out.

With these changes also comes a greater awareness of the need to understand unique transgender mental health challenges and provide culturally sensitive help.

Transgender mental health

It’s important to emphasize that transgender people experience the same kinds of mental health challenges as non-transgender people, and for reasons that may have nothing to do with their gender identity. In an important progressive step towards acceptance, the World Health Organization recently removed ‘gender identity disorder’ from its diagnostic manual for mental health problems.

That said, research shows us that transgender people experience higher rates of mental health problems, such as depression, anxiety and suicide risk. This increased risk may be in part due to the stigma and discrimination transgender people may experience.

A unique challenge related to gender identity is gender dysphoria - a clinical term that acknowledges the psychological distress a person can feel when their gender identity differs from their sex at birth.

Common stressors affecting transgender mental health

The following kinds of unique challenges may contribute to the increased rates of mental health concerns experienced by people who identify as transgender:

  • Gender questioning: Questioning, exploring and redefining gender identity can be a stressful process. It can create fundamental shifts in who we think we are.
  • Coming out: It’s common for people to experience anxiety or other painful emotions when coming out to friends, family and colleagues. While it is often liberating, many people worry about how others will react and whether it will affect their relationships.
  • Transitioning: Some people choose to take various steps to transition to their gender identity. Socially, a person may use a different name or express their gender by dressing differently. Medically, some choose to pursue hormone replacement therapy or surgery. Legally, individuals might pursue the formal recognition of their gender on their passport, for example. The various social, medical and legal aspects of transitioning can be a challenging and stressful processes.
  • Family and relationship challenges: Any relationship can be strained at times. Those with different gender identities can experience unique challenges due to social pressures and cultural expectations. People might feel isolated or alone.
  • Discrimination: As a minority group, people who identify with a different gender may be subjected to inequitable actions. Some people experience bullying or harassment as a result of their gender identification.

You can get help from a growing number of specialized LGBTQIA support services, organizations and charities.


  • Trans Lifeline 1-877-565-8860, a 24/7 hotline staffed by transgender people
  • Youth Talkline (ages 23 and under) 1-800-96-YOUTH
  • Trevor Lifeline 1-866-488-7386 or online chat with LGBTQIA trained counselors
  • National Suicide Prevention Hotline 1-800-273-8255


If you are experiencing mental health challenges, participating in therapy with a mental health practitioner who has knowledge and experience in gender identity issues can help, whether or not your concerns are specifically related to your unique gender identity.

Just about any therapy type can be applied to challenges related to gender identity. You and your therapist will work together to determine which therapeutic approach is the right fit for you.

Support groups

Many communities have local support groups, which can be found by searching the internet using your zip code and search terms like ‘transgender support group’. The LGBT National Help Center is a great place to look for local supports and resources.

Online support communities can be a great way to access like-minded people regardless of your geographical location. You can find online support and resources through The Lesbian, Gay, Bisexual & Transgender Community Center and GLAAD.


Many people find that learning about the experiences of people who are experiencing similar challenges can be helpful. For example, you might like to try the New York Times transgender stories series.

What to look for in a therapist for transgender mental health issues

Consider the following factors when you are choosing a therapist:


Look for a therapist with a current license, regardless of which kind of mental health professional they are. Any therapist can specialize in transgender or gender identity issues, whether they are psychologists, social workers or counselors.

Specialized training

You’ll want to be sure your therapist is committed to ongoing training in gender identity-related issues and has prior experience in the area. This means that you’ll be working with a culturally competent therapist. For example, they’ll understand the difference between gender and sex, and that a range of gender identities are possible.

There is not currently an official credentialing system to recognize therapists who specialize in LGBTQIA issues. Instead, look for a therapist who is a member of a recognized transgender/LGBTQIA professional organization, such as:

Personal fit

Choose a therapist you feel comfortable with and trust. The trusting working relationship between you and your therapist, known as the “therapeutic alliance” can have a huge impact on the efficacy of therapy.

Many therapists themselves identify as transgender or have a particular interest in gender identity issues. They will often include this in their biographies so that it’s easy for you to find when searching for a therapist. Some transgender people find that they are more comfortable working with a therapist who shares a similar identity.

Speak in advance

It’s important to speak to your prospective therapist ahead of time and ask lots of questions about:

  • Their experience and specific training in transgender issues
  • How long they have been working with transgender clients
  • Their familiarity with the WPATH standards of care for the health of transexual, transgender, and gender nonconforming people, which makes recommendations for medical and psychological treatment for transgender people
  • What their views are on transitioning. This will help you to get a sense of whether personal opinions might influence any agenda for therapy. You want to see a therapist who is open to you exploring all possibilities, without trying to change you

Try to speak to a few different therapists before making your mind up.