Being trans or gender diverse is not a mental health condition. However, young trans and gender diverse people often experience additional pressures related to their gender identity and how they are received by their family and their peers when they come out and socially transition, which can affect their mental health.
Trans and gender diverse young people are more likely to experience depression and anxiety than young people who identify with the gender they were assigned at birth. They are also more likely to self-harm. There are also strong links between these higher incidences of mental health problems and experiences of prejudice and discrimination that trans and gender diverse people face.* Importantly, young trans and gender diverse people who are well supported by their family and get psychological support cope better (Gender Identity Development Services, 2020).
The parents and carers we spoke to have a range of experiences related to their children’s mental health. Some parents emphasised that their children have been doing fine, like Georgina who said: ‘I think there’s an awful lot of children who suffer hugely, again going on what the support sites say. But… our son for the most part is a very happy-go-lucky kid.’ Others spoke about their children suffering from anxiety or depression. A few also spoke about their children self-harming or attempting suicide.
In this section, you can read what the parents and carers we spoke to said about:
- The importance of support and affirmation for a child’s mental wellbeing;
- Puberty as a time of additional pressure;
- The positive impact of social transition on a young person’s mental health;
- Impact of long waiting lists on mental health; and
- Getting help.
The importance of support and affirmation for a child’s mental wellbeing
In the context of interpersonal relations, gender affirmation refers to the process where a person’s gender identity and expression are supported and recognised as valid. Gender affirmation is key to trans and gender diverse people’s wellbeing.
In our interviews, parents and carers spoke about how a young person’s wellbeing depends on many, often-connected, factors, and affirming support from the family and school, and access to healthcare play a key role. Ross spoke about how his child’s mental health ‘declined quite badly’ affected by a lack of support from their mother and school, resulting in low self-esteem and low confidence. Lesley felt that not being ‘supported and validated’ had been a factor in her son overdosing and self-harming.
Ross talked about how his child’s relationship with their mother and being bullied at school impacted his child’s mental health.
Some parents and carers we spoke to felt that their own affirming approach – supporting their child’s gender identity and supporting their child’s social transition – have been key to their child’s mental wellbeing. Leigh said about her foster son: ‘If I hadn’t of supported my child to transition socially and in school, to be where he is now, he, I’m not saying he would have taken his own life, cause he wouldn’t… But he wouldn’t be the person, he wouldn’t be doing well in school. He wouldn’t have friends. He wouldn’t have interests. He wouldn’t come out of his room if he was made to live as his birth gender.’
One parent learnt from the experiences of others the importance for parents to affirm a trans or gender diverse child’s gender identity and how ‘rejecting the child’ can lead to mental distress for both parents and the young person.
Mel felt being trans is a huge amount for someone to take on at such a young age’ and talked about helping her step daughter deal with anxiety.
While Interview 1’s daughter is confident and happy, she has seen elsewhere how lack of affirmation from the family negatively impacts a young person’s mental health.
Puberty as a time of additional pressure
Puberty can be a challenging time for trans and gender diverse young people. Bodily changes due to puberty can be sudden and distressing, and sometimes lead to body dysphoria. Parents and carers spoke about distress caused by changes in a child’s voice, facial hair, and other physical developments. For example, Ali’s daughter had panic attacks and ‘became very introverted over that period of time [when puberty started] and extremely anxious.’
Having a female sounding voice has caused anxiety for Ross’s child, who won’t talk to people on the phone.
For parents of pre-pubertal children, like Oonagh, there was the concern that puberty might bring a deterioration in their child’s mental health, as they anticipated some difficulties in how their child would feel about the changes happening to their body.
Oonagh worried that her daughter could be susceptible to a deterioration in mental health’ when puberty started.
You can read more about puberty related pressures here.
The positive impact of social transition on a young person’s mental health
Many people we spoke to talked about how socially transitioning positively affected their child’s mental health. Lisa observed about her son: ‘We had a planned transition over a half term period, where she had her hair cut and immediately I could just see the difference in, she just seemed relaxed as ‘he.’ He …was happier, he was more confident… the impact on my son was remarkably positive. Just looking at himself in the mirror you could see it was almost like awash with relief.’
Ali talked about how her daughter’s mental health has improved after socially transitioning and how she has since ‘met people online and she’s visited them, and she’s got so much more confidence.’ She observed that ‘it took… a long time for her to get the confidence up to come out socially and she’s has (now) completely [come out].’
Ali’s daughter no longer self-harms and there has been a huge improvement in her mental health since her social transition.
Being able to fit in better with his peers was something that Leigh talked about as a positive outcome of her foster son’s social transition. She said that, ‘before his transition, he was the kid in the playground, sat reading a book with no friends. Because he didn’t fit with the girls and he didn’t fit with the boys. They didn’t understand him, because he didn’t understand himself. Once he transitioned, it wasn’t a magic moment, it did take a few weeks. But he managed to create a really nice big social group of boyfriends. Joined in the boy’s things, joined the boy’s clubs and he basically it’s like he blossomed over the first few months.’
Impact of the long waiting list on mental health
The long waiting times to access specialist Gender Identity Services for both children and young adults can affect the young person’s mental health particularly where there is existing body dysphoria, rapid changes due to puberty, or mental health issues. Ross said that his child’s ‘mental health was in such decline that I couldn’t, I couldn’t envisage them being around that long [on the waiting list]. I think they would have probably had a successful suicide attempt, because they were really in decline and depressed, and isolated, and I don’t think they’d have made the two year waiting list.’ Ross decided to explore private healthcare options for his child. Other parents, like Lesley, whose son’s mental health was deteriorating, the long wait meant they felt they also had no choice but to pay for private healthcare.
Lesley talked about the long waiting list and seeking private healthcare for her son, because of his deterioration in mental health.
You can read more about people’s experiences of being on the waiting list to the Gender Identity Development Service.
However, not everyone felt that accessing specialist care would be good for their child. Elijah worried about the long-term mental health of his child and felt the decision to have hormone therapy and surgery too early could lead to a life of ‘physical scarring and unhappiness’. He felt that the long waiting time for Gender Identity Services was good and said: ‘I’m holding out that my daughter will become comfortable in her own skin, which is the most important thing here, to be comfortable in her own body. To be happy as who you are and not pushed into medicate for life. That’s the route I hope she will take.’
Parents and carers we spoke to had varied experiences of getting help for their young person. Not everyone felt their young person needed additional support and for example, Jan stressed that her daughter did not have mental health issues. For other parents, there might have been periods when their young person needed help with their mental health and other times when they were doing fine. Andrew emphasised ‘Our daughter has suffered some mental health issues… We dealt with it ourselves, really. We did phone CAMHS and explained to them, but it was a very quick one day blip and she… was fine the next day. So apart from that she hasn’t had any major, major health issues.’
For parents and carers whose children needed more input from mental health professionals, there were options. Whilst some were able to pay for private counselling or therapy for their young person, others were relying on the of the support Child and Adolescent Mental Health Services (CAMHS).
Some parents praised the positive impact that joining local support groups and getting involved with local LGBT charities had on their young person’s wellbeing. Leigh emphasised the positive influence of ‘finding local support groups for kids.’ She said that for her foster son, being able to be surrounded by other trans youth and ‘being able to be himself everywhere’ and be supported and accepted has been more helpful than anything else. Many parents and carers saw joining support groups as something that was helpful for them too.
Getting the right kind of help at the right time was another issue identified in our interviews with parents and carers. One mother, whose son was on hormone blockers, felt that the time when her son was on the medication should have been used to explore his gender identity with the GIDS, but she also felt the service was not doing that. Another parent also felt that the time the young person was on hormone blockers was when the therapist should ‘come in and be talking about all of the things that they need to talk about to really use that space.’ She felt the GIDS therapists weren’t doing that for her child and that ‘it’s just press this pause button [for puberty] and then he’s in limbo.’
Schools can sometimes offer support to the young person and their family. However, the kind of help available might not always be well suited to the needs of the young person. Ali said about her daughter’s school that ‘the school did provide a bit of support, but it was mainly, she was lumped in with a therapy group for very violent pupils, which wasn’t particularly helpful.’ Other parents spoke about making sure the support offered by the school was ample and at times changing schools if did not meet their child’s needs. For example, Lesley stressed that she did plenty of research to make sure her son would be supported in his new school and that the support would be there in practice and not just on paper.
Lesley looked at what support schools offer when choosing a new school for her son. She felt what was advertised was not always there in reality.
Finally, supporting a trans or gender diverse child can be challenging for parents and carers, who might need support themselves.
Please see our Resources page for links to charities and organisations that offer mental health support to young people and their families.
* LGBT Health and Wellbeing, 2018. LGBTI Populations and Mental Health Inequality.