Content warning: discussions of suicidal feelings and attempts.
Young people we spoke to talked about mental health in a number of different ways. Our participants talked about:
- Separating gender identity and mental health
- Managing other types of stress
- Misgendering and mental health
- Waiting and lack of support
- Dealing with crisis and self-harm
Separating gender identity and mental health
One of the key themes of discussion regarding mental health was the complex relationship between gender identity, gender dysphoria and the impact of this on mental health. .
Participants talked about gender dysphoria contributing to poor mental health, in particular, the relationship they had with their body. Ari and Jessica felt that going through puberty was a trigger for their mental health difficulties. PJ said, ‘Gender dysphoria takes a huge toll on mental health.’ He said, ‘it’s really hard to get up every morning and have to look at your body and know that it’s not right, and it won’t be for a long time.’ He said, ‘showering is really hard and just facing the day, facing people is just a chore. Having to put so much effort into just being a normal human being is really hard.’
Rosa said their gender dysphoria ‘adds to the anxiety I have a lot of the time in social situations, especially with new people and also it’s not been helpful with issues with my self-esteem’.
Jack talks about how his mental health can be exacerbated’ by his gender identity and gender dysphoria and how talking to a private therapist has helped.
For some young people recognising gender dysphoria was key to making sense of their mental health and relieving the pressure. Jessica talked about being depressed for a few years but not knowing why, ‘I was lashing out at people, I was being angry. I was getting aggressive over a lot of things or getting really upset over little things, I couldn’t process why.’ She said, ‘as soon as I realised that I was trans, it kind of clicked, it was this dysphoria that I just hadn’t recognised yet and the recognition helped.’ Jessica said, ‘The minute I realised it, was like a weight had been lifted, I know who I am, and I can be sure of that and so I’ll keep going for a bit.’
Ari talks about their experience of mental health and what contributes to their distress.
Many young people were keen to separate gender dysphoria from other things in their life causing them distress. Patrick said, ‘I don’t think my gender had a huge amount to do with my mental health, I think for me my dysphoria was less connected to my actual mental health because I had so many other things going on with my mental health that weren’t tied to gender.’
Ezio says his gender dysphoria and depression are pretty much separate things.
It was frustrating for trans and gender diverse young people when health professionals automatically presumed a link between gender identity and poor mental health. Declan said his support worker said, ‘It’s because you’re trans you’re stressed,’ He said, ‘she wouldn’t understand that just because I’m trans doesn’t mean I’m stressed, life is stressful because I’m trans, but it doesn’t mean that it’s causing my mental health issues right now. There are other things that are.’
CJ talks about their experiences of counsellors presuming their mental health issues were linked to gender identity.
Participants felt this stigma was prevalent in the structure of gender identity services. Jessica said the pathway to the Gender Identity Development Service (GIDS) through the Child and Adolescent Mental Health Service (CAMHS) is ‘problematic’ since it creates ‘an inherent association between mental health and being trans’.
Cas said one of his biggest fears about accessing a mental health service is the potential ‘to face prejudice and stigma’ for admitting that he is struggling with his mental health as a trans person. Henry said, ‘I was quite conscious of the impact of talking about my mental health on how my want to transition would be perceived’. He worried that a healthcare professional would ‘think twice about supporting me in my transition’. He also worried that his ‘mental health will then become all about my transition’ when instead ‘there are other things going on that,I need to explore.’
Rahul says it’s hard during counselling sessions to convince people that you have other issues in your life than being trans.
Managing other types of stress
Young people spoke about the contributing factors to their mental health outside of gender identity. Our young people talked about different layers of stress that they were experiencing. This included stresses from work and/or study or school pressures, as well as friendship, family and relationship worries. Young people also talked about discrimination and prejudice they experienced generally. Tyra said, ‘Where does [my] anxiety come from? The world!’
A few young people talked about the impact of isolation and loneliness. Sophie said that her mental health ‘took a dip’ because of loneliness which is ‘partly due to my gender identity’. She said she takes antidepressants to help with her depression and sadness from loneliness (see Trans and gender diverse young people’s experiences of getting support for their mental health ). Patrick talked about how he ‘moved around different towns’ but was always ‘super isolated, which made growing up LGBT a little bit more difficult because there wasn’t really a community there.’
Ezio talks about his experience of depression and anxiety very little of it is actually caused by my dysphoria.
Alistair talked about feelings of shame he felt. He said, ‘a lot of the time my mental health issues have been just not being able to fully accept myself’. He said, ‘even though I’m transitioning now and I’m trans and proud, it’s [still] really difficult feeling like you’re not, like everyone else.’
Patrick says I had so many other things going on with my mental health that weren’t tied to gender.
Michelle talks about the multiple events that contributed to a mental health crisis.
Those we spoke to with experiences of university and academia talked about the contributing stress of this environment. M talked about their experience of being trans and in academia, ‘It just felt like I was in between two communities.’ The ‘PhD community research community has such high levels of poor mental health and then the trans community has such high levels of poor mental health’. They said, ‘how do you think I’m meant to survive?’ It was just too much, it was way too much.’
H said he ‘got depressed when I was at uni [and] ended up dropping out’. Declan said, ‘I suffered quite badly at school from bullying and stuff so my mental health around puberty just declined completely’. He said, ‘it stayed like that until I came out’. He added, ‘since then the only kind of bad mental health I’ve experienced is due to like my academic life’.
Shash says, I don’t think I’ve ever spoken to anyone who’s been able to separate their trauma.
The media also had a negative effect on the mental health of our trans and gender diverse young people. Jack said, ‘Transphobic, hateful articles and messages I see in the news a lot, really transphobic just hateful articles and messages coming from everywhere,. does take the toll on you and it does make you feel low, it does make you feel just like alone and isolated so I do see a therapist and kind of talk around that stuff .’
Kat talks about the impact the current attitude towards trans people’ has on her mental health.
Misgendering and mental health
Young people said constant misgendering was a key factor contributing to their mental distress. Summer said, ‘there’s a lot of issues with my mental health that aren’t to do with transition’. However, she said ‘it’s definitely transition, and dysphoria and misgendering have given me levels of anxiety and suicidal thoughts that I never had before.’ She added, ‘it just makes everything worse’.
Misgendering was also a common experience at mental health services. Theo spoke about seeking mental health support and being misgendered even when their medical records say which pronouns to use, ‘it’s just made me feel worse.’
Safia read notes made by a psychiatrist on them and found examples of misgendering and disregarding their experiences.
Declan talks about the relief of not having the constant battle’ of being misgendered at university.
Lack of support and waiting
In our interviews, young people repeatedly talked about the negative impact that waiting for NHS gender identity services had on their mental health. They spoke about the length of time and lack of support they felt. Cas said, ‘There isn’t really much support’ which led to him feeling ‘really, really isolated’ and impacted his mental health. One person said they’d ‘had enough’ of waiting and eventually managed to get private treatment. Ezio described the lack of care for trans and gender diverse people: ‘[the] waiting lists are so aggravating’.
Ari says delays to referrals and treatment while struggling with gender dysphoria makes it seem like there’s no possible way out.
Jacob talks about how being on the waiting list caused him to have suicidal feelings.
Dealing with crisis and self-harm
When talking about mental health experiences, some of the trans and gender diverse young people talked about reaching significant low points and serious crises. Cas said, ‘Mental health in the trans community is actually terrible. I mean 41% suicide attempt rate which is really high.’ For Declan it was the thought ‘that I could never be seen as my true gender’. He said, ‘the fact that I thought I could never be seen as who I actually am made me incredibly low and suicidal’. Ezio thought his self-harm ‘was a mixture of different things, including ‘hatred of the body I have.’
Charke had felt in such a bad state’ in the past that they decided they had to make a change or transition.
Cas talks about self-harm, cutting, and the importance of keeping the wounds clean.
Bailey talks about being scared about disclosing self-harm and suicide attempts to the gender identity services.
Beginning a journey of coming out¬†and transition¬†was described by some as a way to survive their lowest moments. For Alistair coming out was the only way forward from the crisis point where he felt ‘quite suicidal’. Starting his transition as the only way forward, he thought, ‘if I don’t do something now, there’s not really another option so this is kind of it.’ He was grateful for private healthcare because he felt that ‘if I had still been on a waiting list without anything happening like I’m not sure I would, I can be here, like I felt it was really bad’.
Rahul says if I didn’t come out as trans, I didn’t really want to be alive.
Begam describes their feelings of ending it’ saying it’s been a difficult, emotional journey.
Begam talks about their experiences of self-harm and cutting emotional strain and pressure to release.
If you are having suicidal thoughts and feelings and need to talk to someone you can find support and contact details on the NHS website- help for suicidal thoughts. You can also find more information about self-harm NHS website- self harm. You can also read supportive messages from trans young people.
You can also find the mental health support services in your area by visiting the NHS website ‚ÄìFind Mental health support services locations.