The American Psychological Association defines 'transgender' (often shortened to 'trans') as an umbrella term for individuals whose gender identity or gender expression does not conform to that typically associated with the sex to which they were assigned at birth.

In this definition, gender is not to be confused with sex. Assigned at birth, sex refers to one's biological status as either male or female, and is associated mainly with physical attributes such as anatomy. Gender, though, refers to the roles, behaviors, activities, and attributes that a given society considers appropriate for boys and men or girls and women. Gender identity, then, refers to an individual's internal sense of being either male or female or perhaps neither. And gender expression refers to the way a person communicates this sense of identity through behavior, clothing, voice, or body characteristics. Some transgender people have surgeries or take hormones to bring their bodies into alignment with their gender identities, but many do not wish to medically alter their bodies.

In either case, trans people are often seen by others as non-conforming to a natural or inherited identity and so they are stigmatized; for this reason the National Alliance on Mental Illness suggests trans people are prone to depression and anxiety.

Mental Health Issues

Societal stigma and the resulting prejudice and discrimination trans people face from society at large and, possibly, from family members, peers, co-workers and classmates often exacts a high price. The Centers for Disease Control and Prevention (CDC) reports that not only trans youth but those who identify as lesbian, gay and bisexual are at increased risk for suicidal thoughts and behaviors, suicide attempts, and suicide. (Conversely, the CDC reports that students, no matter sexual orientation, reported the lowest levels of depression, suicidal feelings, alcohol and marijuana use, and unexcused absences from school when they were in a positive school climate and not experiencing homophobic teasing.)

A study published within the last few months sought to assess the relationship between 'minority stress' and mental health in a large, geographically diverse sample of the transgender population in the U.S. 'Minority stress theory' proposes that the health disparities among sexual minorities can be explained to a large extent by stressors induced by a hostile and homophobic culture, which often results in a lifetime of harassment, maltreatment, discrimination and victimization and may ultimately impact access to care. Underlying the concept of minority stress are assumptions that stressors are unique (not experienced by other populations), chronic (related to social and cultural structures) and socially-based (embedded within institutions and structures as well as processes).

The objective of this study, then, was to apply this theory strictly to people identifying as transgender. To accomplish this, researchers recruited, through the Internet, a sample of 1,093 male-to-female and female-to-male transgender persons. Stratified by gender, participants completed an online survey that included standardized measures of mental health. Guided by the tenets of minority stress theory, researchers evaluated the relationship between stigma and mental health; then, they tested whether indicators of resilience (family support, peer support, identity pride) moderated this association.

The researchers found a connection between stigma and a respondent's psychological distress; the trans participants expressed signs of clinical depression (44.1 percent), anxiety (33.2 percent), and somatization (27.5 percent), in which their mental state was converted into physical symptoms. Trans people, clearly, fit the minority stress model.

Yet, the researchers also discovered that support from other transgender people moderated the effects of anxiety and depression. And, in the very best cases, respondents found encouragement within their families and this also softened the blow of stigmatization.

Homes and Hearts

Generally, no matter an individual's gender identity or sexual orientation, it is helpful to rely on family for support when clinically depressed. However, many trans people are without this source of comfort because their families cannot accept their gender identity. Research published in the journal Pediatrics and conducted by Caitlin Ryan, PhD, Director of the Family Acceptance Project at San Francisco State University, has established a predictive link between specific, negative family reactions to a child's sexual orientation and serious health problems in young adulthood. Compared with lesbian, gay, bisexual and trans (LGBT) young adults who experienced very little or no parental rejection, LGBT young adults who experienced high levels of rejection were:

  • Nearly six times as likely to have high levels of depression;

  • More than eight times as likely to have attempted suicide;

  • More than three times as likely to use illegal drugs; and

  • More than three times as likely to engage in unprotected sexual behaviors that put them at increased risk for HIV and other sexually transmitted infections.

Because mental illness as well as gender non-conformity is still stigmatized in our society, many transgender individuals suffering with depression are in the unfortunate position of having to contend with two stigmas, which in turn can exacerbate their mental health problems. When a people who identifies as trans has internalized society's negative view of them, it is often the case that they do not seek out the treatment they need.


In another recent study that examined mental healthcare use in a sample of 130 transgender volunteers, researchers found that roughly a third of participants sought treatment for mental health issues including depression, anxiety, and relationship problems. Sixty-eight participants (52 percent of the participants) showed evidence of psychological distress but had not received mental health services in the past year. The barriers to seeking mental health services included cost of treatment, previous bad experiences, and fear of treatment. Frequently cited by participants who did not seek out health services were stigma concerns; they feared mistreatment at the hands of someone who could not understand them.

And this is significant: after all, no easy explanation exists for why some people are transgender. Some researchers believe that biological factors, including genetics and prenatal hormone levels, as well as experiences in early life and adolescence or even adulthood may all contribute to the development of a trans identity. Although the term may be relatively new, transgender identities are not. Anthropologists have documented trans people in indigenous, Western, and Eastern cultures and societies from long years past up to the present day. For instance, native Americans referred to some members of their tribe as "two spirit" as it was believed such individuals had two spirits occupying one body. Mixing traditionally male and female articles of clothing, they performed distinct roles in their tribes, according to scholars. These roles included: healers, conveyors of oral traditions and songs, foretellers of the future, potters, and matchmakers.

Sources: Bockting WO, Miner MH, Romine RES, Hamilton A, Coleman E. Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population. American Journal of Public Health. 2013.

Shipherd JC, Green KE, Abramovitz S. Transgender Clients: Identifying and Minimizing Barriers to Mental Health Treatment. Journal of Gay & Lesbian Mental Health. 2010.