Depression in Transgender Teens

depressed teen

While feelings of sadness, worthlessness, and feeling left out of social situations are common experiences for most teens, teenagers who identify as transgender are at a higher risk of experiencing a variety of mental health symptoms, including depression, anxiety, suicidal, risk-taking behaviors, substance use, self-harm, etc. A study from the American Academy of Pediatrics revealed that 41.8 percent of transgender youth in their study indicated that they had attempted suicide, which is a drastically different percentage from the general population of Americans over 18 which falls around .6 percent. These studies show that transgender children, teens, and adults alike are in need of gender-affirming supportive services to help them improve their functioning throughout life.

The reasons behind these numbers have to do with what is going on internally for transgender teens, as well as what is going on around them. Obviously, having a gender identity or gender expression that is in contrast with the gender assigned to them at birth is something that can cause a person to experience significant distress in their life. Some have related the experience to feeling like they are in the wrong body, and the constant reminders of this contradiction happen every day that they navigate their life; people calling them a name that doesn’t feel like theirs, feeling obligated to fit into a gender stereotype that they don’t feel comfortable in, and all of the natural assumptions people make about others based on their biological gender. This dichotomy causes many to feel distressed, helpless, and lost within their own minds, and the choice to continue to follow the path of their biological gender roles can be difficult to do without experiencing significant mental health symptoms. When a teen or adult is experiencing distress from their gender identity, it is classified by mental health professionals as gender dysphoria. Here is the criteria for gender dysphoria according to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) they must be experiencing at least two of the following for at least 6 months:

  • A marked in-congruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
  • A strong desire to be rid of one’s primary and/or secondary sex characteristics
  • A strong desire for the primary and/or secondary sex characteristics of the other gender
  • A strong desire to be of the other gender
  • A strong desire to be treated as the other gender
  • A strong conviction that one has the typical feelings and reactions of the other gender

In addition to the feelings that can come from within a person who identifies as a transgender teen, the way that gender has been socially constructed in our world also complicates their ability to understand and define themselves. From the minute a child is conceived, the first questions most people ask is about the sex of the baby- “Is it a boy or a girl?”. With this question comes all the stereotypical assumptions of what the baby-to-be will be like; if they are a girl, she will be sweet and beautiful, dressed in frilly dresses and pink, playing with barbie dolls and kitchen sets. If they are a boy, a baby shower filled with blue decorations and toys like trucks, tools, and action figures are likely to be seen. Boys are assumed to be rough, high energy, sports-lovers who will “wear out” their parents.

Stereotypes like these don’t come out of nowhere; they come from the fact that this is often how boys and girls differ! But this is not a biological predisposition as much as it is societally constructed. From the minute a child is born, the parents begin to dress them and present them with gender selected toys, décor, and clothing and the way they interact and engage with their children can help them to develop the personalities that either align or misalign with current gender norms. So, when a child begins to experience distress because they are not feeling connected to the gender they were assigned at birth, the societal backlash that comes from this can cause additional stress and turmoil in the person’s life. Studies have shown that children and teens whose identities are not supported show more symptoms of mental health concerns than those who do have support from their family, friends, and community. So, if a person is not accepted when they come to the conclusion that they are transgender, they are more likely to experience the negative mental health symptoms that come along with it.

Research continues to show that supporting a child’s chosen identity and helping them obtain gender-affirming support is the best way to help them navigate the difficulties they may experience as a result of identifying as transgender. Mental health clinicians who provide gender-affirming treatment can help a transgender teen learn coping skills to manage some of their depressive thoughts, feelings, and behaviors in ways that can help them rather than hurt them. Teens in general who struggle with depression, transgender or not, will often try to cope with their depression in risky and dangerous ways, so getting assistance for symptoms of depression early can help them learn healthier ways to improve their mood and behavior for life.

Here are some signs and symptoms that you or someone you know may be experiencing depression:

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  • Must be experiencing 5+  of the following symptoms for more than 2-weeks to the point where it is causing a significant impact on their school, work, or social functioning:
    • Depressed mood most of the day, nearly every day.
    •  Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
    • Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.
    • A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
    • Fatigue or loss of energy nearly every day.
    •  Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
    • Diminished ability to think or concentrate, or indecisiveness, nearly every day.
    • Recurrent thoughts of death, recurrent suicidal idealization without a specific plan, or a suicide attempt or a specific plan for committing suicide.

If you identify that you or someone you know meets criteria for these symptoms and appears to be experiencing gender dysphoria, or significant struggles with gender identity, seeking help from a gender-affirming, supportive mental health professional can help you to improve your quality of life and help you make the decisions you need to make to help you feel more happy, healthy, and fulfilled.

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Dr. Shannon McHugh is a Licensed Clinical and Forensic Psychologist in Los Angeles, California. She specializes in assessment and treatment of children, adolescents, and adults who have developmental and social delays, behavioral difficulties, and those who have experienced traumatic events
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