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Jaiden Blancaflor was a sophomore in high school when they called The Trevor Project’s helpline. Blancaflor, a 17-year-old who identifies as transgender and goes by he/they pronouns, was feeling overwhelmed and experiencing a severe episode of gender dysphoria, a term that refers to the emotional distress that can occur when the gender you’re assigned at birth doesn’t align with the gender you know yourself to be. After calling the helpline, they were quickly connected to an operator who understood how to help and patiently talked Blancaflor through their feelings.

“Before the call, I didn’t like how I was living my life; I wanted more interaction with the LGBTQ+ community,” Blancaflor says. “I felt alone, like all my friends were cis, straight people. After we talked, I felt more understood — more valid, and it felt like what I was going through was more legitimate.” After Blancaflor hung up, they sat down and made a list of ways they could get more involved with the LGBTQ+ organizations at their school. “I started writing down things to look forward to and ways I could relieve some of the stress I was feeling about schoolwork,” Blancaflor says. “I decided I should start planning Pride Week with my school’s GSA [Gender and Sexuality Alliance].” The support Blancaflor received ultimately made them feel understood, and led to becoming more connected with the LGBTQ+ community.

Mental health support can make a huge difference for transgender people like Blancaflor. Studies have found that trans people who experience gender incongruence (another term for dysphoria) are more likely to experience depression, anxiety, and suicidality. But for trans people who seek mental health care, finding a gender-affirming medical professional who is qualified to address the discrimination and erasure they face every day is crucial — and not always easy.

Understanding trans patients means understanding that being trans, in and of itself, is not a mental health condition, says Genny Beemyn, PhD, the director of the Stonewall Center at the University of Massachusetts, Amherst, who uses they/them/their pronouns. The current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, includes gender dysphoria, a classification that many advocates say casts unnecessary shame and assumptions on trans folks. In 2018, The World Health Organization stopped classifying gender incongruence as a mental health condition in order to “depathologize transgender identities.”

Instead, Dr. Beemyn says that the mental health struggles of trans people largely stem from their stigmatization in society and not because of their gender identity. “Any higher prevalence of mental health issues comes about because of the way society treats them,” Dr. Beemyn says.

Living in a world that erases, discriminates against, and even kills trans people for simply existing can lead to depression and mood disorders. Trans people of color may be even more likely to experience depressive symptoms, brought on by exposure to both racist and transphobic discrimination, found a study in the journal Ethnicity and Inequalities in Health and Social Care. At least 34 trans people have been murdered this year, though that number may be higher, given that many people are misgendered by police, healthcare professionals, and even coroners and family members, says a.t. furuya, the youth programs manager at GLSEN, an education organization that aims to make schools more inclusive, who uses they/them pronouns. In 2017, 16 states considered “bathroom bills” that would require public restrooms to be separated by sex assigned at birth. The Trump Administration banned transgender service members from the military and proposed a reinterpretation of Title IX — which prohibits sex discrimination in federally funded schools — that was discriminatory toward trans students. President-Elect Joe Biden was the first person in the office to thank the transgender community in a victory address, which is a step in the right direction, but there’s still a long way to go.

Research shows that gender-affirming support, however, can be hugely protective as we work toward creating a more inclusive world for trans folks. While experiences of prejudice and fear of anti-trans stigma are associated with a higher risk of depression and suicide, those who reported having greater social support had a lower risk of these outcomes, a survey study in the Journal of Counseling Psychology found. Other research showed that transgender kids who were allowed to present their gender identity and change their names had good mental health outcomes, reports the journal Pediatrics. Therapists, helplines, and resources that help trans people change their names, find transition-related healthcare, or even connect with safe and gender-affirming hairstylists can all be invaluable tools that promote mental wellbeing.

But transgender folks face unique barriers to accessing mental health care. They can face issues with insurance, or have no insurance. What’s more, one in three transgender and nonbinary youths said they didn’t receive or seek out mental health care because they felt a provider wouldn’t understand their sexual orientation or gender identity, according to research from The Trevor Project published earlier this year. This isn’t a baseless fear. Multiple people Refinery29 spoke to for this story said they’d previously seen a therapist who tried to convince them that they were not actually trans or discouraged them from being their true selves. And trans people who delay seeking healthcare because of fear of being discriminated against had worse general health and mental health outcomes, a study in the journal Transgender Health found.

One root of the problem may be that many medical schools don’t adequately prepare future doctors for treating LGBTQ+ patients. In 2019, NPR reported that many medical school lectures about LGBTQ+ health issues were electives, and some were even taught by students themselves. 

So, trans-inclusive and trans-competent mental health resources are essential, explains IV Staklo, who uses he/him and they/them pronouns and is the hotline program director at Trans Lifeline, which connects trans people to trans counselors when they’re in crisis or need a place to talk. “[LGBTQ+-specific organizations] have the education around the LGBT community and know how specifically to help,” notes Blancaflor. “If you’ve been called a certain word at school, a regular hotline might not know the severity or history behind the word. But these hotlines can better understand the experience.”

Trans people also cited other fears as preventing them from seeking help, including comparing their problems to others’. A 2020 Trevor Project survey asked trans youth why they didn’t receive mental health services they desired. “There were a lot of students who said, ‘I feel like there’s a lot of people who have it worse,’” explains Amy Green, PhD, the vice president of research at The Trevor Project. “Despite high levels of depression and anxiety… A lot of youth are pulling back and saying, ‘I really would like mental health care, but maybe I’m not quite deserving of it.’” Blancaflor agrees that this is a common phenomenon. “I know a lot of LGBT students who’ve felt like, ’My issue is not that severe compared to other people’s issues,” they say. “When really it’s a lack of understanding about impact and severity.”  

Blancaflor describes growing up with loving, supportive parents who largely accepted their transition when they began coming out in middle school. But if they had fallen into the mindset Green describes — I can push through alone, because someone else probably has it worse — they wouldn’t have called the Trevor hotline a few years ago, and may not have gotten the help they needed.

This is why connecting to other trans community members is often a key aspect of mental health care. We live in a society that’s transphobic, and if you don’t know other trans people, it can be easy to feel alone, explains Staklo. “Before I had trans friends, I saw a mental health professional who regularly tried to convince me I’m not trans,” Staklo says. “She would regularly misgender me… I thought that was normal. If I had a bunch of trans friends at that time, they would have told me to get out of there.”

Any organization that helps you find community can make a difference. For Blancaflor, that ultimately meant more connection with the LGBTQ+ student group GLSEN and the Gender and Sexuality Alliance at their school. They also started reaching out to people who are trans via social media. “My biggest recommendation is: If your parents are monitoring your social media, make an alt account and follow LGBT accounts and hashtags so you can get to know the community,” they say. Of course, use safe practices on social to protect yourself and others. As Staklo says, community makes a difference, and mental health organizations are seeking to make those connections. Staklo says some of their favorite calls they get at the Trans Lifeline hotline are from people who are dialing back to say they made a bunch of trans friends.

As Blancaflor says: “Having those resources is just life changing. There’s a difference between having a community versus knowing a community exists.” 

Where To Find Trans-Centered Mental Health Resources: 

TrevorLifeline

Call 866­-488­-7386 to reach a trained counselors, 24/7. The resource, created by The Trevor Project, is intended for anyone who is “a young person in crisis, feeling suicidal, or in need of a safe and judgment-free place to talk.”

TrevorText

Another Trevor Project resource, this confidential and secure service provides live help for LGBTQ youth with a trained specialist over text messages.

Trans Lifeline Hotline 

Call 877-565- 8860. This peer line, created by the Trans Lifeline, connects trans people to other trans people. You can call when in crisis or when you need a place to talk. The hotline has a strict policy against non-consensual active rescue. That means if you’re considering suicide, they won’t call police or emergency services on you unless you want them to. Bri Barnett, the director of development and communications at Trans Lifeline, says this is because police can often be more than a threat to trans people than an ally. 

Microgrants 

This organization, also a Trans Lifeline resource, provides trans and nonbinary folks with funding to cover the cost of updating and correcting names or gender markers on identifying legal documents.

RAD Remedy 

This website’s mission is to connect trans, gender non-conforming, and nonbinary folks to safe, accurate, and respectful health care. You can use it to find everything, from gender affirming therapists to hormone treatments near you. 

National Center For Transgener Equality 

This organization has an incredibly thorough list of resources for trans folks looking for mental health care, including support hotlines, insurance help, legal resources, incarceration resources, immigration resources, employment, veteran, and employment services. 

Your local LGBTQ+ Center

Of all the experts we spoke to, everyone said that the best way to connect with a community and affirming doctors, therapists, and mental health professionals was to go through your local LGBTQ+ center, and get recommendations from them. Not sure where to start? Google “LGBTQ+ center” with the name of your town. If that doesn’t pull up results, try the name of the city closest to you.

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Molly Longman, Khareem Sudlow