Issues in Transgender Mental Health

Over the past couple of years, I have come to develop a growing interest and expertise in working with gender variant children and adolescents experiencing Gender Dysphoria and related issues.  I thought it was about time that I write a little blog about issues in transgender mental health and how a psychologist can help.

Gender Dysphoria is a sense of unease and dissatisfaction with the biological sex one is born with. Gender Dysphoria can mimic other mental disorders like anxiety, depression, social withdrawal, etc.  This discomfort often acts as a catalyst to change one’s body and gender expression (how one presents to the world) to be more in accordance with one’s gender identity (the gender that one feels oneself to be).

I find this graphic useful in providing an understanding of the differences between biological sex, sexual attraction, gender identity and gender expression:

Early childhood - Some children start displaying a preference for gender variant behaviour at a young age. Many parents are unsure about how to respond to their child's desire and worry about the impact this preference could have on their school and social lives.  Most young children who display "cross-gendered" behaviour do not go on to become transgendered adults.

Puberty is a time when the body begins to change and adapt gender specific features (breasts, changes in genitals, voice, hair growth, menses, etc.).  Most transgendered individuals report experiencing intense dysphoria when their bodies begin to change.  Many transgendered individuals become more aware of their identity by this age, but lack the financial resources and power to make any significant changes.  

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.  When the adolescent is old enough to make an informed decision about the risks/benefits of hormone replacement therapy (HRT), puberty can commence in the gender of preference.

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

Later Adulthood – Some transgendered individuals delay 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 physically "passable" outcome.  Furthermore, these individuals often regret having waited so long to transition and friends and family may have difficult time adjusting to the changing identity of someone they have known for so many years.

Deciding what to do – Making decisions about transitioning, what level to transition to, or whether to attempt any transition at all 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, etc.  There can also 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).  It is important to note that there is no singular path that every trans person takes.  They each have different experiences and make different decisions.  Some individuals assume an identity as “gender queer” or “gender neutral” and some decide not to transition at all.

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, facial hair removal and voice changes.
• Frustration of having to change or explain legal documents (drivers license, passport, titles to property, diplomas, etc)

Psychotherapy can help transgendered clients as they travel through the process of finding fulfillment in who they are.