Trans and mental health

Transgender people report higher rates of depression, anxiety disorders, autism, ADHD, eating disorders and suicidality than cisgender controls.

Higher prevalence

Transgender people report higher rates of depression, anxiety disorders, autism, ADHD, eating disorders and suicidality than cisgender controls. The ‘minority stress’ model explains part of this in terms of discrimination, isolation and internal conflicts.

Effect of transition

Research shows that transition reduces dysphoria-related symptoms for many transgender people, but does not automatically resolve comorbid conditions. The Dutch cohort study by Wiepjes (2020) showed that the risk of death by suicide remains elevated even after transition.

Implications for care

International guidelines emphasise the importance of integrated mental healthcare alongside medical transition. This prevents underlying problems from remaining untreated and provides support for broader identity development.

What came first

The minority stress model assumes that psychological complaints result from rejection and discrimination. This explains part of the picture, but not everything. In many young people presenting in recent years, psychological problems existed before discomfort about gender began. Finnish researchers described this in 2015: three-quarters of the adolescents in their clinic had previously received psychiatric treatment. In that case, discomfort with the body may also be an expression of underlying problems. See, for example, OCD and transgender identity.

What long-term research shows

The Swedish study by Dhejne from 2011 followed transgender people who had undergone surgery for thirty years and found a much higher rate of death by suicide than in the general population. The Amsterdam study by Wiepjes found that the risk remained approximately the same throughout the process. A 2019 Swedish study that reported an improvement after surgery was corrected a year later; see Bränström 2019. The research does not rule out the possibility that transition helps people, but neither does it prove this. What the cohort studies show about symptoms that persist after transition is available at genderellende.nl.

For those seeking help

Psychological complaints deserve treatment in their own right, regardless of how someone feels about transition. Anyone feeling depressed or anxious can contact their GP and does not need to wait for an appointment at a gender clinic. Are you thinking about suicide or worried about someone? Call 113 Suicide Prevention on 0800-0113 or chat via 113.nl. See also depression and transgender identity, autism and transgender identity and psychological support.