Transgender people are more likely to experience mental distress due to the social disapproval and discrimination that they encounter.
Research in the areas of employment, health provision, social exclusion and hate crime indicates that transgender or trans people (people who don't conform to the traditional division of male and female) experience higher levels of discrimination, harassment and violence.
Consequently, trans people are at greater risk of depression, self-harm and suicide. A 2007 survey of 872 trans people found that 34% of respondents had considered suicide. This is considerably higher than the general population.
Many trans people have experienced:
- a lack of understanding from family, friends, employers, medical professionals and others
- difficulty in finding work or retaining work once their background becomes known to others
- rejection by family and friends
- transphobic comments
- violent intimidation on the streets and outside their homes
- being stared at or laughed at when out shopping
- bullying and name-calling
"The main issues that affect the mental wellbeing of trans people are related to discrimination," says Ady Davis, a psychosexual therapist with the North-East Gender Dysphoria Service.
As a result of discrimination, trans people can have conflicted and confused feelings. The conflict may lie within themselves. For example, their trans status may go against their religious beliefs.
The conflict may lie in their relationship with the people around them. Their parents, school or workplace may send the message that people expressing themselves in the opposite gender wouldn't be tolerated. There's also wider discrimination from society.
"Some trans people," says Davis, "can't do everyday activities such as going shopping without getting stared at, attracting comments, having their self-esteem knocked or experiencing violence on occasion."
"When you put them together, all these difficulties can have a massive impact on mental health," says Davis.
"Trans people may isolate themselves, and they may experience feelings of depression, suicide or self-harm. For example, they may mutilate their bodies by trying to remove the parts they're not happy with, such as their breasts or penis. They may also start using alcohol or drugs as a way to escape."
1 When to seek help about your mental wellbeing
You may be questioning your gender, or you may feel that you should be the opposite gender, or you may feel that you don't have a gender.
"If this is a temporary doubt that lasts no more than a few months, it may be something you resolve yourself," says Davis. "But if your feelings of gender discomfort are consistent, you can get support that can help you feel more comfortable with your gender identity."
The first step is to see your GP. You'll then be referred directly to a gender identity service or to the local mental health service. Many services provide help not just to the people directly affected, but also to their families.
You may prefer to get in touch with community support groups. To find groups in your area for trans people and their families, contact any of the charities listed below in Support for trans people. Search for 'transgender support' plus your location on the internet. Local lesbian, gay and bisexual groups also have information about support for trans people.
If you think that you're depressed, or you're having thoughts of self-harm or suicide as well as discomfort about your gender identity, get help immediately. Either contact your GP or call NHS Direct 111. You can also contact helplines such as Samaritans (08457 90 90 90) for confidential, non-judgemental emotional support.
2 What type of psychological therapy is available?
Treatment depends on the individual's needs. "For example, someone may want to express a female side but fear of telling a partner is preventing them," says Davis. "In this case, a therapist would help the trans person to express those feelings, and to work out how they would be accepted in the relationship. The therapist may talk to the partner as well. If they accept it, that may be enough.
"All types of treatment generally aim to get someone to a point where they feel more content in their gender," says Davis.
3 Emotional support for trans people
As a result of discrimination and prejudice, many trans people feel isolated. Meeting other trans people and realising that you're not alone can boost your confidence. There are several charities that can put you in contact with other trans people. These include The Gender Trust, Mermaids 1 and The Beaumont Society 2.