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Basic Issues in Transgender Mental Health

This page contains a short outline of issues that arise for transgendered individuals, particularly those effecting one’s emotional and psychological state.  I hope to expand on many of these in future posts (check the ‘categories’).

Gender Dysphoria – This is a fundamental unease and dissatisfaction with the biological sex one is born with which results in anxiety, depression, restlessness, and other symptoms.  The dysphoria often acts as a catalyst to change one’s body and gender expression (how one presents to the world) to be more in keeping with what is felt to be one’s gender identity (the gender that one feels oneself to be).

Problems associated with growing up with Gender Dysphoria – The main problem of growing up with gender Dysphoria, aside from the body dysphoria itself is the social predicament.  Essentially everyone expects the individual to be and act like a boy/girl, when they feel inside to be a girl/boy.


Early Childhood – Children get cues early on from parents about appropriate behavior, and internalize them.  For example MTF (male to female) transsexuals have reported getting the message from parents that it wasn’t ok for them to play dolls with their sisters or neighbors, and that they were expected to do “boy” things – like rough and tumble play.  Kids of this age start to get the idea that there is a part of themselves that must remain hidden.

Puberty – This is a particularly hard age, since the body begins to change and adapt gender specific features (breasts, changes in genitals, menses, etc..).  Transgendered individuals have reported “I was disgusted by (hair, breasts…etc)”.   Many transgendered individuals are aware of their issue by this age, but lack the means and agency to effect any change.  This has been changing in recent years where some transgendered youth are more “out”, have supportive families and are able to access services.

In some cases medication is available to “delay” puberty until the individual is old enough to decide whether or not to transition.  This has the benefit of essentially avoiding the trauma of experiencing the physical effects of puberty in the unwanted gender.


Early Adulthood – With emotional and financial independence some people feel free to begin to address transgendered issues at this age and look into transitioning.  However, some are not as free to do so, due to family and other obligations, or due to lack of information and access to services.

Later Adulthood – Some transgendered individuals put off transitioning until later in life when they feel able to do so.  This can be satisfying, but can also have the disadvantage of  producing a less convincing outcome.   In addition there can be regret about having lived so long in an unwanted gender.  Friends and family may have a harder time understanding what is happening since they knew the person for so long in their natal gender.

In all stages – There can be isolation, hiding and secrets, which can lead to depression and anxiety.  Transgender adults are much more likely to have suicidal thoughts, with 50% of adults reporting some suicidal ideation.  There seem to be two paths that people take early on: either one tries to hide their inner feeling of being the wrong sex and “passes” for what looks like a boy or girl, or one is incapable of hiding and presents as either a tom-boyish girl or a feminine boy.  Either path is fraught with problems for one’s emotional development.  The second scenario – of presenting as gender non-conforming is known to elicit harsh responses from society.  This is true for non-transgendered people as well and many gay men and women experience this early on.


Deciding what to do – This is a big part of the transgendered Individuals experience.  Making decisions about transitioning, what level to transition to, or whether to attempt any transition at all are complicated decisions and require time and support.  There are fears of how one will be accepted by family (parents, partners, children, grandparents and others), friends, colleges, fellow students, church groups, etc..  There can be anxiety about ‘passing’ or how convincing one will be to others as a man or woman (i.e. whether or not one will be “read” as transgendered).

There can also be the wish to not completely transition, but assume an identity as “gender queer” or “third sex”.  All are perfectly acceptable options.  Usually one doesn’t start at that place, so this requires some form of transitioning as well.   At the point of decision making, many things are unknown and it can be very stressful.  It can also be exciting and joyful to be able to act and move towards a more authentic self.

Transitioning – For those transgendered individuals who decide to transition (to present and live in the other sex outwardly), these emotional/psychological issues may come up:

  • Fears about finding a partner
  • Impact on family relationships with parents, children, partners and other relatives
  • Impact of relationships at work and with friends.
  • Fears about violence and prejudice when one is read as transgendered.
  • Feelings about having to experience surgeries, hormones, (and for MTF transsexuals) facial hair removal and voice changes.
  • Frustration of having to change or explain legal documents (drivers license, passport, titles to property, diplomas, etc)

Post transition issues – Some issues that may arise include:

  • Disappointment that transitioning didn’t solve all problems.
  • Level of satisfaction with appearance
  • Level of satisfaction with any surgeries
  • Emotional issues that were not addressed before.


When one decides not to transition. Not everyone is able or wants to transition. This is a perfectly valid choice for people to make.  However these individuals must learn to cope with the tension that the gender dysphoria produces.  Sometimes this can be helped by having times when one can cross-dress, interact with others who are aware of one’s status, talk about the issue, and take low-levels of hormones (that don’t effect the body outwardly).

Other mental health issues not related to being transgendered. Just because some one is transgendered doesn’t mean they don’t have other issues in their lives.  It can be hard for some people to let themselves seek treatment for other issues when the gender dysphoria is so prominent a concern.

The good news: It’s important not to lose sight of the  satisfaction one can have by acknowledging and (if possible) changing what can be changed and moving towards of one’s authentic self

Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.

7 Comments Post a comment
  1. Thank you for your insight into transgender issues, as I finish a post about this topic.

    April 30, 2014
  2. Isle #

    great info. thank you for the insight

    May 26, 2014
  3. A comprehensive understanding of the many issues facing TG individuals prior to, during Transition, and Post-Op.

    Helen Beck Transgender Awareness Trainer/Adviser/Mentor, United Kingdom

    October 20, 2014
  4. Hadijah n #

    Thank you for your insight into transgender issues, the world needs this information to create a free society free from human isolation and abuse.

    November 20, 2014
  5. very informative and helpful writing on transgender. I have experienced my life of feeling different as early as age 3. I am transitioning later in life. I am a male to female transgender who struggles with suicidal thoughts and bouts with insomnia every day. I have a family and a son who needs me but I struggle every day with my transgender situation. it is a very difficult life. thank you for this well written article. emily

    November 24, 2014
  6. Carol #

    I also thank you. For every thansgender that we see there must be a thousand of us hiding. We’re your plumbers, mechanics, big 6’4″ guys with the beards, We’ve been hiding most of us since we were only 3 or 4 years old. We’re masters of the disguise to the point that it clouds our reality. As for me I’m what appears to be a masculine home renovations contractor. I live my life primarily in male mode but in the past 2 years I’ve come out to everyone that I am close to including family,siblings and children. I’ve even taken on the practice of coming out to my clients and today 70% of my clientele know the real me. My biggest problem has always been an honesty issue and hiding or mascarading is just not honest. Still have so much to deal with but at least I’m being honest and forthcoming to the people who care for me. Oh yea! Thus far there hasn’t been 1 negative reaction and I’ve received nothing but support even from the ones that I feared the most.
    Best reaction was when my cousin exclaimed “Finally!” I finally understand you now.

    December 3, 2014
    • Lana #

      This is so encouraging, Carol! I’m 30, and feminine even by the average male standards. I am so distraught – living in Asia, Catholic, with a conservative family, social and work context – I feel suffocated at the realization that I am in fact transgender. I wish I’d never realized this.

      Now I see the light, and it seems a cruel joke. Something I can desire with all my heart but only at great personal sacrifice, and at much trauma to others. I’d always known I’d liked boys, but the lack of awareness – of groups and fora as this, even the internet came to me late – always made me classify myself as gay. That didn’t quite sit right. And now that I know :) I suppose self-realization helps.

      I am SO happy for your transitioning, and the immense support and encouragement you receive from your family, friends and colleagues! As someone who quite possibly sees life as a study in solitude, I wish you ALL the very best! You deserve it! : )


      January 6, 2015

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