By Matthew Oransky, PhD
I’m a psychologist at a nationally-recognized adolescent health center, and over half of my transgender patients have thought about suicide.
This should be shocking, but it’s not. According to a recent national study, a heartbreaking 40% of transgender adults said they had tried to commit suicide. 92% of these individuals had tried before they turned 25. For comparison, only 8% of high school students have attempted suicide.
Preventing suicide among trans and gender non-conforming (TGNC) youth goes beyond managing crises. It requires meaningful social change. This National Suicide Prevention Week, let’s talk about how we can end this epidemic and make our world more affirming of the lives of TGNC individuals.
Why do so many TGNC teens attempt suicide?
Being TGNC is not responsible for the high levels of mental distress in TGNC youth. Society—namely its marginalization of and violence toward trans-ness—is responsible.
A critical factor that influences young TGNC people’s mental health is whether their family accepts and affirms them. When family rejects them, young TGNC people feel deeply invalidated and unseen by the most important people in their life.
This not only causes deep and lasting pain, but isolates these young people and creates additional stress factors. TGNC teens may be kicked out of their home or feel unsafe there due to violence, abuse or conflict. This is partly why LGBTQ individuals make up 20-40% of the youth homeless population, and TGNC folk experience homelessness at 2.5 times the rates for the general population. Young TGNC people are also more likely to be in foster care, experience substance abuse, and engage in survival sex.
TGNC individuals also experience a range of other stressors, such as anxiety about using public restrooms and showing their IDs, and being misgendered or called the wrong name. Many also experience bullying and harassment at school, discrimination, abuse, and other forms of structural and interpersonal violence.
In addition, TGNC people often (but not always) deal with gender dysphoria (which one of my patients describes here). Gender dysphoria is the anxiety and pain that comes from discrepancies between a person’s body and their gender identity. This anxiety often intensifies during puberty, as young people’s bodies become increasingly misaligned with their true gender. This can lead to suicidal thoughts.
What needs to change?
TGNC suicide and mental health is not just a medical problem. It is a social justice issue that ultimately requires dismantling the oppressive gender binary. This may seem like a massive task, but it’s essential for TGNC people’s well-being. Here are some specific pieces of our society that need to change.
TGNC youth need access to affordable, gender-affirming medical and mental health care. Transitioning can make a huge difference in a young TGNC person’s mental health. In addition, TGNC people need to be able to seek other health services without fear of harassment or being misgendered.
Young people increasingly understand that gender exists on a continuum. We need to keep educating others about what it means to be TGNC and the effects that the gender binary has on our society. Over time, education can reduce the stigma and isolation of TGNC communities as families, medical providers, educators, and community leaders stop rejecting TGNC youth and begin to fully embrace them.
TGNC youth also need more role models. Seeing TGNC adults leading healthy, fulfilling lives gives them more people to look up to. It can help them envision their own future, helping alleviate suicidal thoughts.
What can I do for the TGNC youth in my life?
Whether you (know that you) know someone who is TGNC or not, you can examine your own assumptions about gender, and begin thinking about your own privilege and how cisnormativity has benefited you.
If you’re a parent, I co-wrote a guide to supporting your transgender child which you can find here.
If you have a young TGNC person in your life, you can:
- Be affirming. Use their true name and pronouns. Let them know you understand and accept that they are trans or gender non-conforming.
- Don’t ASSUME they’re suicidal or depressed. While rates of suicide are higher in the trans population, not all TGNC people are suicidal or have mental health issues. Listen to what they say about their own experience.
- Know that they are more than their trans-ness. TGNC people are complete, complicated people just like everyone else, and they have a lot going on in their lives outside of being TGNC!
- Help connect them to resources—I list some good ones below.
- Be an advocate. Let them know you’re on their side. This may mean educating others, helping them fight for their school rights, find gender-affirming health care providers, or change their name and gender markers.
- Support gender-affirming spaces in the community, whether that’s a high school club, inclusive medical practice, support group, or other welcoming space.
The Mount Sinai Adolescent Health Center provides completely free, comprehensive health care to 10-22 year olds in NYC. We have a program designed for TGNC youth, which includes primary care, transition services including puberty blockers and hormone replacement therapy, mental health services including a TGNC support group, and legal services. Call 212-423-3000 to make an appointment.
Gender Spectrum provides information for families, healthcare professionals, educators and more about gender and how to create gender inclusive environments.
Matthew Oransky, PhD is the Director of Psychology Training at Mount Sinai Adolescent Health Center, oversees the integration of mental health services into the medical clinic and co-coordinates services for transgender and gender non-conforming youth.
The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.