Disclosure | Official Trailer | Netflix
Dad Speaks Out Against Trans Bill in Defense of Daughter Mar 16, 2021
Transgender Rights with John Oliver
What is intersex? with Katie Couric
What I realized about men -- after I transitioned genders
I've lived as a man & a woman
Uncomfortable Truths in Sex Research
Michael Bailey -
Truth Decay: Part 1
Forging Hate
Rain Dove Plays With Their Gender to
Free Your Mind
Pete Buttigieg To Mike Pence: 'Your Quarrel, Sir, Is With My Creator' 4/8/19
How To Be An Ally To Trans People
Protect Trans Youth (I Just Need to Pee)
Protect Obamacare + Transgender Health
Beautiful traqnswomen with their stunning update videos
"Trans Ideology is the New Homophobia" - Arielle Scarcella
Trans Ballerina Jayna Ledford is Shattering Stereotypes
NPR Tiny Desk Contest 2023 - Andrea Gibson - MAGA HAT IN THE CHEMO ROOM
Hey Doc, some boys are born girls:
What the experts don't want you to know about Trans Vginoplasty
The Research on Sexuality They Don't Want You to See - Michael Bailey
TSA Body Scanners
TSA Detains Young Boy for Invasive Pat Down

Rain Dove
Rain Dove Plays With Their Gender to
Free Your Mind
Understand Each Other
Gender Bending model Rain Dove talks about looking different
What Is (Trans)Gender? | #EducateDontHate | ft. Rain Dove | Rose Montoya

Transsexual people experience a gender identity that is inconsistent with, or not culturally associated with, their assigned sex, and desire to permanently transition to the gender with which they identify, usually seeking medical assistance (including sex reassignment therapies, such as hormone replacement therapy and sex reassignment surgery) to help them align their body with their identified sex or gender.

Transgender - Original Reporting at
Maren Morris’ ‘Lunatic Country Music Person’ T-Shirt
Raises Over $100K for Transgender Causes - 9/3/22

Beyond He or She
Rethinking Gender
Then and Now Before and After
What Does Transgender Mean?
What Does Transsexual Mean?
Gender Revolution A Journey with Katie Couric National Geographic Special Issue
Gender Revolution 2017
Sexuality-Gay, Bi, Trans
How a Men's Training has progressed with this non-binary issue 22:07
Talking About Transgender People & Restrooms - A 13 page pdf
LGBT & Gender Non-Conforming (GNC) Girls Face in the CriminL Justicer System
Transgender in America
Rapid Onset Gender Dysphoria (ROGD)

Rapid-onset gender dysphoria controversy - Wikipedia

Deployed, Trans and Out
2015 U.S. Transgender Survey - Oregon
Two Percent of High School Students Identify as Transgender - CDC Report Finds
Oregon's Equality Profile
Frequently Asked Questions about Transgender People
What Percentage of the Population is Transgender - 2022 - Oregon Ranked 8th
How Many Adults and Youth Identify as Transgender in the United States? - 2017
How Many Adults Identify as Transgender in the United States? - 2016
Race and Ethnicity of Adults Who Identify as Transgender in the United States? - 2015
How Many Adults and Youth Identify as Transgender in Oregon? - 2017
Estimated number of transgender people has doubled, UCLA researchers say
Basic Rights Oregon - Transgender Justice

When Transgender Travelers Walk Into Scanners, Invasive Searches Sometimes Wait on the Other Side
The trauma of TSA for transgender travelers - CNN
Traveling as a trans person: It’s complicated - CNN
The Horrible Things That Happen to Trans People Going Through Airport Security
Step in the right direction': TSA to adopt gender-neutral screening to be more inclusive - USA Today
What to expect when geettig a new TSA pat-down - ACLU

How has the population changed in Oregon? 2010 vs 2020
Few Transgender Children Change Their Minds After 5 Years, Study Finds NYT 5/4/22
Testosterone Rule: Transgender Women and Competitive Sports
Valentina Sampaio announces she will be Victoria's Secret's first openly transgender model
Find out if you have Gender Dysphoria - Take this mental health test. It’s quick, free and you’ll get your confidential results instantly.

Advocates, families and transgender students push for progress in Oregon schools Support for transgender students in Oregon schools goes beyond Salem-Keizer
The Science About Trans Youth in America
Is gender identity biologically hard-wired?
Brain Sex in Transgender Women Is Shifted towards Gender Identity
Americans Strongly Support Trans Rights — In Some Cases - 5/26/21
A Researcher Is Trying To Settle The Transgender Athlete Debate - Using Science
Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care - 2/25/22

Queering is Caring 3/7/23
How to Talk to Your Kids About Sexuality and Sexual Orientation
Truth Decay: Part 1 - Forging Hate 4/16/21
A Closer Look: Bisexual Transgender People
Transgender: By the numbers
Understanding the Stigma Faced by Transgender Women
Between the (Gender) Lines: the Science of Transgender Identity
Stop asking me if my eight-year-old trans kid is just going through a phase - 3/30/21
Gender-Affirming Chest Surgeries Increase by Nearly 5x in Teens - 10/17/22
Violence against those facing racism, misogyny, and transphobia is an epidemic within an epidemic - 12/18/20
Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972–2017
How the Bathroom Wars Shaped America
What is the difference between transsexual and transgender?
The Difference Between Transgender and Transsexual Women
Dangerous Privilege: Trans Men, Masculinities, and Changing Perceptions of Safety
Trans Men Experience Far More Violence Than Most People Assume - 7/23/15
Violence against transgender women in the United States
The Breakdown: Surge in Violence Against Trans Women
Regional gray matter variation in male-to-female transsexualism
Male-to-female transsexuals have female neuron numbers in a limbic nucle
Philly’s surprising arrest rate in reported violence against trans women this year: 100% - 11/13/20
Violence against trans women: How many more? - 10/12/20
After 2 Trans Women Are Killed In 2 Weeks, Activists Beg City To Take Crimes More Seriously — And To Stop Misgendering Victims
Who Is Committing Violence Against Trans Women? - 10/20
For trans women of color facing 'epidemic' of violence, each day is a fight for survival: 'I'm an endangered species… but I cannot stop living' - 11/20/19
Prohibiting Gender-Affirming Medical Care for Youth
Gender Identity Non-Discrimination Laws in Public Accommodations
Public Opinion of Transgender Rights in the United States
California Could Be Next State to Repeal Discriminatory “Walking While Trans” Law - 3/10/21
Singular 'They' in Grammar
TransActive Gender Project
LGBTQ Youth Report 2018
Find out if you have Gender Dysphoria
Gendered Violence (4 page PDF)
Another Health Crisis: Violence Against Black Trans Women in America - 7/20/20

After 2 Trans Women Are Killed In 2 Weeks, Activists Beg City To Take Crimes More Seriously — And To Stop Misgendering Victims
The Problem: America’s Treatment of Black Trans Women
America’s War on Black Trans Women
Two Recent Murders of Black Trans Women in Texas Reveal a Nationwide Crisis, Advocates Say
For trans women of color facing 'epidemic' of violence, each day is a fight for survival: 'I'm an endangered species… but I cannot stop living'


California Will Now Recognize Nonbinary Identities on Death Certificates - 7/13/21
Suicide Thoughts and Attempts Among Transgender Adults
Why do Transgender People Die by Suicide?New Study Reveals Shocking Rates of Attempted Suicide Among Trans Adolescents - 9/12/21
New Study Reveals Shocking Rates of Attempted Suicide Among Trans Adolescents
Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972–2017) (Abridged)
Transgender people and suicide
The suicide rate for transgender people is nearly 10 times the national rate. A center is changing that
Attempted Suicide Rate for Multiracial Transgender People Thirty-Three Times Higher than General Population
Studies: Suicide attempts high among transgender teens, increasing among black teens - 10/14/19
Psychosocial mediators of perceived stigma and suicidal ideation among transgender women
Suicide Thoughts and Attempts Among Transgender Adults: Findings from the 2015 U.S. (36 page PDF) September, 2019
Suicide Thoughts and Attempts Among Transgender Adults: Findings from the 2015 U.S. (36 page PDF) September, 2019
Trans Key Stats


Read more
23 Sexual Orientations
Comprehensive List of LGBATQQI + Term Definitions
Sexual Orientation
Gender-specific and gender-neutral pronouns
Prefered Pronoun - her, she, them
Online Transgender Support Groups
National Survey on LGBTQ Youth Mental Health 2020
Legislative Tracker: Anti-Transgender Legislation
Definition of Terms: Sex, Gender, Gender Identity, Sexual Orientation - American Psychological Association
Sexual Orientation and Gender
Transexual Documentary 45:00 National Geographic
Ladyboys Episode
1 2 3 4 5 6

Violence against those facing racism, misogyny, and transphobia is an epidemic within an epidemic. - 12/18/20

Of at least 41 trans and gender nonconforming people murdered in 2020, more than half have been Black trans women. In a year of sadly historic levels of fatal violence against the trans community, this is an epidemic within an epidemic.

“It comes down to this: There needs to be a shift in our culture as to who is seen as having value,” Tre’Andre Valentine, executive director of the Massachusetts Transgender Political Coalition, told me during a recent interview. “As a society, we don’t talk enough about the violence that has been enacted on Black women — and that also means Black trans women.”

Trans people and their allies are fighting to change the narrative. After the police killing of George Floyd in May, antiracism protests sparked nationwide marches for trans rights and in memory of Black trans people murdered this year. If we say the names of Atatiana Jefferson and Breonna Taylor, we must also speak out for Nina Pop and Tiffany Harris.

“Black people — and brown people and indigenous people — are constantly having to insert and assert who they are, and have their identities recognized,” Valentine said. “They should be able to do that without compromise or violence or backlash. When we talk about Black people, when we say ‘Black lives matter,’ we mean all Black people.”

In columns this month, I’ve been memorializing every trans and gender nonconforming person lost to violence in 2020, according to Human Rights Campaign. That list, including Black trans women, continues here.

Brian “Egypt” Powers, 43, on June 13 in Akron, Ohio: Powers, who once dreamt of being a dancer for Janet Jackson or Paula Abdul found stability working for a friend’s catering company. Just as distinctive as his cooking were his colorful braids, or his “unicorn braids,” as Powers called them.

Brayla Stone, 17, on June 25 in Little Rock, Ark.: David Johns, executive director of the National Black Justice Coalition, said Stone died “because we live in a society where it is not yet explicit that when we say Black Lives Matter we mean all Black lives, which includes Black trans women and girls.”

Merci Mack, 22, on June 30 in Dallas: Mack loved to spoil her nieces and nephews. “That’s the kind of auntie she was: ‘I don’t care what your mama said, come get in this car, and we’re going to get some ice cream,’” Tyeshia Rickett, Mack’s sister, said. “They loved her.”

Shaki Peters, 32, on July 1 in Amite City, La.: A performance artist, Peters was remembered by her friend Nathalie Nia Faulk as “consistently laughing, consistently joking, the first person to get up and dance.” Peters, she said, “was the person who would come to you and be like, ‘How are you? Are you okay?’”

Bree Black, 27, on July 3 in Pompano Beach, Fla.: Shenika Harris, a Florida attorney and a spokesperson for Black’s family, said, “They have a hole in their family. They are hurting.”

Summer Taylor, 24, on July 4 in Seattle: Taylor’s mother described them (Taylor used non-binary pronouns) as “A burst of creativity, wit, and charm, with a heart of empathy.” Taylor was an ardent supporter of the Black Lives Matter movement, and would want to be remembered as an ally of Black lives, their mother said.

Marilyn Cazares, 22, on July 16 in Brawley, Calif.: Mindy Garcia, Cazares’ aunt, said her niece “loved to sing and dance.” She called Cazares “very brave,” “very outspoken,” and “very loved.”

Tiffany Harris, 32, on July 26 in Bronx, N.Y.: On her Facebook page, Harris, also known as Dior H. Ova, wrote about her favorite TV dramas like “Desperate Housewives,” “Sex and the City,” and “Nip/Tuck,” as well as her love of fashion.

Queasha D. Hardy, 22, on July 27 in Baton Rouge, La.: With her rainbow nail polish and brightly colored hair, which could range from electric blue to fire engine red, Hardy stood out. As a popular hairstylist, she made sure her clients did as well. Friends remember her as “always smiling” and “the life of all parties.”

Aja Raquell Rhone-Spears, 34, on July 28 in Portland, Ore.: Rhone-Spears, a businesswoman, also volunteered at a nonprofit that helps children transition out of foster care. Her sister, Nicola Spears, said, “She went through a lot in her childhood growing up, so I believe with other kids she just wanted them to be happy and not have to deal with what she had to deal with.”

Renée Graham can be reached at Follow her on Twitter @reneeygraham

A Closer Look: Bisexual Transgender People

The Bottom Line

There is little data on the experiences of bisexual transgender people. Research on LGBT people is growing, but when the data are disaggregated to look at the disparities or resilience of particular groups under the LGBT umbrella, the sample size is often too small to analyze with confidence.

Download 4 page PDF

The 2015 U.S. Transgender Survey, conducted by the National Center for Transgender Equality, offers a unique opportunity to examine the lives, experiences, disparities, and resilience of bisexual transgender people. A Closer Look: Bisexual Transgender People analyzes data from the U.S. Transgender Survey, documents disparities for bisexual people and offers recommendations for remedying those disparities.

What is the difference between transsexual and transgender?

Sex and gender can be considered in biological and cultural ways. Biological sex refers to a person’s anatomy. Typically, a biological male has a penis and testes. A biological female has a vagina and ovaries.

Gender is rooted more in culture and environment. Most cultures have social customs and activities that are associated with males and females. For example, children may be given certain gender-specific toys to play with. In some cultures, this might mean toy cars and trucks for boys and dolls and dress-up clothes for girls. Likewise, the children might be raised to take on certain roles – or have certain expectations – as adults, based on their gender.

In general terms, the word transgender refers to people who identify differently from their biological sex. For example, a transgender person who is biologically female may feel that a male identity is a better fit and take the following steps:

  • Use a male name instead of a female name.
  • Use male pronouns instead of female pronouns.
  • Dress as a man.
  • Engage in activities that are typically associated with men in that culture.

A transsexual is a person who physically transitions from male to female or vice versa.

He or she might take hormones to suppress the characteristics of the biological gender or promote the characteristics of the desired gender. In this way, transsexuals can control, to some extent, traits like facial hair and breast development.

Transsexuals may also decide to have gender reassignment surgery, in which – to the extent that is possible – the anatomical features of the biological gender are removed and the features of the desired gender are added.

These definitions are not strict, however. Some feel that the word transsexual should not always refer to physical changes. And some transsexuals no longer refer to themselves as such after they have finished their transition. They call themselves either men or women.

The words are also complex in light of culture and the passage of time. What is considered typical male or female dress or behavior in one culture may be considered unusual in another. And what may have been typical gender expression a century ago may not be the case today.

The Difference Between Transgender and Transsexual Women

Transgender and transsexual are commonly confused terms that both refer to gender identity. Transgender is a broader, more inclusive category that includes all individuals who do not identify with the gender that corresponds to the sex they were assigned at birth. Transsexual is a more narrow category that includes individuals who desire to physically transition to the sex that corresponds with the gender with which they identify. (Note that the word "gender" is usually used to refer to social and cultural roles, while "sex" refers to physical attributes.)

All transsexual persons are transgender. However, not all transgender persons are transsexual. Transgender women are sometimes referred to as trans women. Some may also be known as male-to-female transsexuals, MTFs, transsexual women, transgirls, or tgirls. The term "transsexual" originated as a medical term and is sometimes considered pejorative. It is always best to ask a person which term is preferred.

Transgender vs. Transsexual

Although they both refer to gender identity, transgender and transsexual are terms with distinct meanings. That they are often used interchangeably has led to some confusion. In most cases, a transgender woman is a woman who was designated (also commonly referred to as "assigned") male at birth but who identifies as a woman. Some transgender women may use the term AMAB (assigned male at birth) in describing their identity. She may take steps to transition, but these steps do not necessarily involve surgery or physical alterations. She may dress as a woman, refer to herself as a woman, or use a feminine name. (Note that some trans men may use the term AFAB, or assigned female at birth.)

Not all transgender persons, however, identify with the man/woman, masculine/feminine binary. Some identify as gender nonconforming, nonbinary, genderqueer, androgynous, or "third gender." For this reason, it is important never to assume that a transgender person identifies with a particular gender nor to assume what pronouns a person uses.


A transsexual woman is one who desires to physically transition to the sex that corresponds with the gender with which she identifies. Transitioning often includes taking hormones to suppress the physical characteristics of her assigned gender. Many transsexual women in the U.S. take hormone supplements, which can promote breast growth, change vocal pitch, and contribute in other ways to a more traditionally feminine appearance. A transsexual might even undergo gender reassignment surgery (also referred to as "gender confirmation surgery" or "gender affirming surgery"), where the anatomical features of the gender and sex assigned at birth are physically altered or removed.

Strictly speaking, there's no such thing as a "sex change operation." A woman can elect to have cosmetic surgeries done to alter her physical appearance to match conventional norms associated with the gender with which she identifies, but anyone can have these procedures done, regardless of their gender identity. These surgeries are not limited to transsexual people.

Gender Identity vs. Sexual Orientation

Gender identity is often confused with sexual orientation. The latter, however, refers only to a person's "enduring emotional, romantic or sexual attraction to other people" and is not related to gender identity. A transgender woman, for example, may be attracted to women, men, both, or neither and this orientation has no bearing on her gender identity. She may identify as gay or lesbian, straight, bisexual, asexual, or may not name her orientation at all.

Transgender vs. Transvestite

Transgender women are often incorrectly identified as "transvestites." A transvestite, however, is an individual who wears clothing primarily associated with the gender with whom he or she does not identify. A man may prefer to dress as a woman, but this does not make him transgender if he does not identify as a woman.

Dangerous Privilege: Trans Men, Masculinities, and Changing Perceptions of Safety


This article examines the construction of masculinities in social interaction through in-depth interviews with trans men living in the San Francisco Bay Area. Interviewees' concerns for safety, particularly the threat of violence from other men, shaped their masculine practices, which led some men to practice defensive masculinities and, for others, constrained their ability to practice transformative masculinities. Respondents' concerns for safety, and their masculine practices, changed according to variation in transition, physical location, audience, and their physical stature. These findings have implications for the relationship between men's fear of violent victimization and accountability to situated gender expectations in interaction and the persistence of gender inequality. Theoretically, this article engages a complex understanding of accountability and multiple masculinities to argue that the perceived threat of violence shapes men's practices in interaction. The fear of violence encourages conformity and inhibits men's transformative practices.

Violence against transgender women in the United States

Violence against transgender women in the United States includes sexual, physical, and emotional violence. These acts of gender-based violence may result in the death of a transgender woman. The stigma surrounding the transgender community and those who are gender non-conforming accompanied by the assumption of their sexual orientation is often cited as the reason for these brutal acts.[1] Data does not show that gender-based violence against transgender women happens at a higher rate than violence against cisgender women.[citation needed] However, young transgender women of color experience violence and murder at a rate much higher than that of their white transgender counterparts.[1]


Sexual violence

Sexual violence is defined by the Centers for Disease Control and Prevention as an "experience of a sexual act (e.g., rape, unwanted sexual touching, pressure or coercion to engage in sexual acts) committed against an individual without their freely given consent".[2] The documentation of sexual assault cases against transgender individuals is limited. However, in a study conducted by Rebecca L. Strotzer in 2009, researchers found that approximately 50% of the transgender community has been affected by sexual violence. This figure is higher than the 43.9% of cisgender women who have experienced an act of sexual violence in their lifetime.[3] [4] In a separate study conducted on transgender Chicago residents by Kenagy in 2005, 62% of transgender women reported that they had been victims of rape which is significantly higher than the 30% of transgender men that reported instances of forced sexual intercourse.[5]

Instances of sexual violence against transgender women happen for the first time at the median age of 15 years old.[6] The notion that transgender youth are more likely to experience acts of sexual violence has been verified by several other studies. These acts occur most often by peers and other young people. This is attributed to the way that their peers view their gender identity.[1]

Perpetrators of sexual violence against transgender women are often known by the victim, in some instances they are romantic partners or family members. A 2005 study found that, out of the instances reported by the transgender men and women, 90% of the participants said that they had been sexually assaulted by a cisgender man. Around 30% of the participants also reported being sexually assaulted at some time by a cisgender woman and 16% reported being assaulted by another transgender individual.[7]

Physical violence

Physical violence in this context is used to describe any physical interaction between two or more individuals with the intent to cause bodily harm. Physical violence against the transgender community occurs at a rate similar to that of sexual violence.[3] A study conducted of transgender individuals in Virginia found that 40% of those interviewed had experienced an instance of physical violence. Of those instances, the participants claimed that around 69% occurred because of their gender identity. The assaults occurred at a median age of 16 and were reported as early as 13 years old. At least 12% of the participants who had been assaulted previously had reported that they experienced over 20 instances of physical violence in their lifetime.[6]

Transgender women that are sex workers experience a disproportionately higher level of violence in the United States.[3] A study of MTF (male to female) transgender sex workers conducted in Washington D.C found that approximately 65% of those interviewed reported an instance of physical assault, most often by their customers.[8] When asked why they believe that they are assaulted, the transgender sex workers answered that it was because their client misunderstood their anatomy as a transgender woman. One participant stated that if the male clients see "female" breasts and "male" genitals, they expect to get a "knife through [the] throat".[9]

Emotional violence

Emotional violence in this context refers to verbal abuse directed at a person or persons with the intent to harm or humiliate the victim. In a recent study of crimes reported against transgender individuals, the researchers found that in many instances there were reports of verbal abuse directed towards the victims. The examples of verbal abuse reported during the crimes included homophobic and transphobic slurs and language. These attacks were mainly towards their gender and perceived identity. These examples of verbal abuse label the attacks as a hate crime.[1}

Violence against transgender women of color

Young transgender women of color experience violence and murder at a rate much higher than that of their white transgender counterparts.[1] A study conducted by the Gender Public Advocacy Coalition sought to examine the transgender murder rate from 1995 to 2005. The study focused on victims that were under the age of 30. Of the 51 victims that they analyzed, 91% of them were people of color. In a separate study conducted by Garofalo et al. (2006), the self-report survey revealed that 52% of the 51 transgender women of color had experienced unwanted sexual intercourse. This study also found that MTF transgender youth of color are at risk of homelessness, substance abuse, and contracting HIV.[10]

Violence towards trans women of colour is often perpetrated by a romantic partner or a potential romantic partner. Cisgender men have been found to dehumanize transgender women of color based on stereotypes that they associate with the community, for example that transgender women of color perform sex work or suffer from substance abuse. These stereotypes has been perpetuated by both straight and gay cisgender men that are seeking a romantic relationship with a transgender woman of color. Transgender women of color also report that cisgender men often engage in the hyper-sexualization of the community, leading to trans women feeling objectified.[11]

Cisgender men that enter a romantic relationship with a transgender woman of color often conceal their romantic involvement; this includes refusal to be seen with a transgender woman in public, on social media, or in any way that might suggest a relationship. This has been attributed to the social stigma surrounding these women.[11]

These forms of rejection, concealment, and over sexualization may result in psychological trauma. Some transgender women of color have reported that they have never been in a healthy relationship. This deeply affects their feelings of self worth.[11]

Resources for transgender women experiencing violence

There are several resources available for members of the LGBTQ+ community when they are in times of crisis. A notable organization is the Trevor Project, which is the leading resource for the LGBTQ+ youth that assists with crisis intervention and suicide prevention.TREVOR Crisis Hotline: 1-866-488-7386 or Text "START" to 678678

Another available resource is the Trans Lifeline, which is an organization that provides a hotline for direct emotional and financial support to transgender individuals.[12] Trans Lifeline - 877-565-8860


1 Stotzer, Rebecca L. (September 2017). "Data Sources Hinder Our Understanding of Transgender Murders". American Journal of Public Health. 107 (9): 1362–1363. doi:10.2105/ajph.2017.303973. ISSN 0090-0036. PMC 5551619. PMID 28787204.

2 Basile, Kathleen C.; Saltzman, Linda E. (2002). "Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements". PsycEXTRA Dataset. doi:10.1037/e721362007-001. Retrieved 2020-11-13.

3 Stotzer, Rebecca L. (May 2009). "Violence against transgender people: A review of United States data". Aggression and Violent Behavior. 14 (3): 170–179. doi:10.1016/j.avb.2009.01.006. ISSN 1359-1789.

4 Smith, Laramie R.; Yore, Jennifer; Triplett, Daniel P.; Urada, Lianne; Nemoto, Tooru; Raj, Anita (August 2017). "Impact of Sexual Violence Across the Lifespan on HIV Risk Behaviors Among Transgender Women and Cisgender People Living With HIV". JAIDS Journal of Acquired Immune Deficiency Syndromes. 75 (4): 408–416. doi:10.1097/QAI.0000000000001423. ISSN 1525-4135. PMC 5810354. PMID 28653970.

5 Kenagy, Gretchen P.; Bostwick, Wendy B. (2005-10-11). "Health and Social Service Needs of Transgender People in Chicago". International Journal of Transgenderism. 8 (2–3): 57–66. doi:10.1300/j485v08n02_06. ISSN 1553-2739. S2CID 143089850.

6 Xavier, Jessica; Honnold, Julie A.; Bradford, Judith (2007). "The Health, Health Related Needs, and Lifecourse Experiences of Transgender Virginians". PsycEXTRA Dataset. doi:10.1037/e544442014-001. Retrieved 2020-11-13.

7 Cook-Daniels, Loree (2008). "Transgender Aging Special Topics: Sexuality, Sexual Violence, and Elder Abuse". PsycEXTRA Dataset. doi:10.1037/e497232008-001. Retrieved 2020-11-13.

8 Valera, Roberto J.; Sawyer, Robin G.; Schiraldi, Glenn R. (2001-01-01). "Perceived Health Needs of Inner-City Street Prostitutes: A Preliminary Study". American Journal of Health Behavior. 25 (1): 50–59. doi:10.5993/ajhb.25.1.6. ISSN 1087-3244. PMID 11289729.

9 Nemoto, T.; Operario, D.; Keatley, J.; Villegas, D. (August 2004). "Social context of HIV risk behaviours among male-to-female transgenders of colour". AIDS Care. 16 (6): 724–735. doi:10.1080/09540120413331269567. ISSN 0954-0121. PMID 15370060. S2CID 35253652.

10 Garofalo, Robert; Deleon, Joanne; Osmer, Elizabeth; Doll, Mary; Harper, Gary W. (March 2006). "Overlooked, misunderstood and at-risk: Exploring the lives and HIV risk of ethnic minority male-to-female transgender youth". Journal of Adolescent Health. 38 (3): 230–236. doi:10.1016/j.jadohealth.2005.03.023. ISSN 1054-139X. PMID 16488820.

11 Gamarel, Kristi E.; Jadwin-Cakmak, Laura; King, Wesley M.; Lacombe-Duncan, Ashley; Trammell, Racquelle; Reyes, Lilianna A.; Burks, Cierra; Rivera, Bré; Arnold, Emily; Harper, Gary W. (2020-11-30). "Stigma Experienced by Transgender Women of Color in Their Dating and Romantic Relationships: Implications for Gender-based Violence Prevention Programs". Journal of Interpersonal Violence. doi:10.1177/0886260520976186. PMID 33256510. S2CID 227246930.

12 "GLAAD", The SAGE Encyclopedia of LGBTQ Studies, 2455 Teller Road, Thousand Oaks, California 91320: SAGE Publications, Inc., 2016, doi:10.4135/9781483371283.n173, ISBN 978-1-4833-7130-6, retrieved 2020-12-10

Trans Men Experience Far More Violence Than Most People Assume - 7/23/15

Boys Do Cry: When we expand violence data beyond hate crimes, it's clear that trans men are targeted at comparable rates to trans women.

Violence against transmasculine folks is an issue that is currently very much underdiscussed. Part of this invisibility problem stems from the current focus on just one aspect of violence against trans people: hate violence that results in death. But there are other kinds of violence we need to be taking into account to get a full picture, including sexual assault, domestic violelnce, and stalking.

The sources of statistics on anti-trans violence mostly come from the Transgender Day of Remembrance list and the National Coalition of Anti-Violence Programs’s annual hate violence reports, which for the past few years have been able to report on the presumed gender identity, sexual orientation, and race of the victims who come to their attention. It is important to note that both of these compilations rely almost exclusively on what is reported by the media — in other words, what mainstream reporters hear about and think is worthy of an article or broadcast. And data does, indeed, show that trans women of color are far more at risk of being murdered than other trans or LGB people.

However, what is far less discussed by the media or within the trans/LGB community is that other types of violence — the kinds of violence that affect thousands more trans people than do hate crimes resulting in murder — actually happen at least as often to transmasculine individuals as transfeminine individuals.

FORGE, the nonprofit I direct policy and programs for, conducted a national study in 2011 that was approved by the Morehouse College School of Medicine Institutional Review Board and funded by the Office for Victims of Crime. Our survery was answered by 1,005 trans people. That study shows that transmasculine individuals were actually more likely to be victims of childhood sexual assault, adult sexual assault, dating violence, domestic violence, and stalking than were transfeminine individuals (as shown in the chart below).

The only category in which trans women were more likely to be victimized was by hate violence, and even there the difference was small: 30 percent of trans women reported having experienced hate violence, compared to 29 percent of trans men.

Sources of data that break out violence by gender identity are currently scarce. The National Coalition of Anti-Violence Programs does not report by gender vector in either of its annual reports on intimate partner violence and hate crimes, and the National Center for Transgender Equality and National LGBTQ Task Force’s 2011 study Injustice at Every Turn typically asked respondents only about violence they felt was caused by their gender identity or expression, which means that much of the violence people experience routinely in their everyday lives may not have been reported on that survey.

What Injustice at Every Turn did document is what several authors in The Advocate's "Boys Do Cry" series have written about: that experiencing violence can lead to suicide and suicide attempts. While the overall attempted suicide rate for all the Injustice at Every Turn respondents was the commonly reported figure of 41 percent, for those who had experienced physical assault it rose to 61 percent. Sexual assault survivors had a 64 percent attempt rate and 65 percent of those who experienced domestic violence had attempted suicide.

These figures make it clear that sexual assault and domestic violence can be as potentially fatal as hate crimes.

We need to pay attention to ending all forms of violence — acts that end in death by self or others as well as violence in the form of nonfatal physical, sexual, or emotional harm. We also must help survivors be heard and helped, since survivors who are not heard and validated have increased risks of mental health challenges, substance use, suicidal thoughts and attempts, and other physical health risks.

Speaking of help, even more of it is available than was mentioned so far in the Boys Do Cry series. Domestic violence and sexual assault programs that are funded by the Violence Against Women Act can no longer discriminate against survivors who are male, transgender, and/or LGB. If you experience such provider discrimination, file a complaint so it can be fixed!

In addition, FORGE has developed many training webinars and technical assistance publications that can help providers better serve transgender survivors, all available free at our website. Three publications that are especially relevant for intimate partner violence include: Trans-Specific Power and Control Tactics, Safety Planning: A Guide for Transgender and Gender Non-Conforming Individuals Who Are Experiencing Intimate Partner Violence, and Let’s Talk About It: A Transgender Survivor’s Guide to Accessing Therapy. We also have a number of self-help publications online and in the pipeline for survivors or people who may be in abusive relationships.

If you are an LGBT person who is or you believe may be experiencing intimate partner violence, you can reach the GLBTQ Domestic Violence Project at (800) 832-1901. The National Domestic Violence Hotline can also be reached all day at (800) 799-7233. If you are a trans or gender-nonconforming person (or partner of such), you can call (414) 559-2123 for FORGE to help direct you to local resources. To file a complaint of discrimination against a domestic violence or sexual assault program, go to the Office of Justice Programs' website.

A Closer Look: Bisexual Transgender People

The Bottom Line

There is little data on the experiences of bisexual transgender people. Research on LGBT people is growing, but when the data are disaggregated to look at the disparities or resilience of particular groups under the LGBT umbrella, the sample size is often too small to analyze with confidence.

Download 4 page PDF

The 2015 U.S. Transgender Survey, conducted by the National Center for Transgender Equality, offers a unique opportunity to examine the lives, experiences, disparities, and resilience of bisexual transgender people. A Closer Look: Bisexual Transgender People analyzes data from the U.S. Transgender Survey, documents disparities for bisexual people and offers recommendations for remedying those disparities.

The Breakdown: Surge in Violence Against Trans Women

The One Big Thing

Two Trans Women Killed In The Same Maryland Neighborhood

Last Thursday, a Black transgender woman was killed in a Maryland neighborhood where another Black transgender woman was killed in March of this year. Zoe Spears, 23, was declared dead at the scene of the crime after being shot multiple times. As Buzzfeed News reports, “she is at least the 10th trans woman to be killed in the United States this year.” These deaths are part of a larger crisis facing black transgender women who are being murdered at extremely high rates. “According to available tracking, fatal anti-transgender violence in the U.S. is on the rise, and most victims were black transgender women,” said AMA Board member S. Bobby Mukkamala in a statement from the association.

Who Is Committing Violence Against Trans Women? - 10/20

“I was hoping we’d get through these last weeks of 2019 without any more murders,” journalist Monica Roberts wrote last December on her blog, TransGriot. “Unfortunately that will not be the case.... Her name is Yahira Nesby.”

Since 2012, Roberts has tracked the stories of people killed by transphobia-related violence; she is now a preeminent source on the subject, cited by national outlets like NBC News and MSNBC. TransGriot’s annual list of trans deaths typically includes more than 20 victims, mostly Black trans women. (Nesby was the 24th trans woman and 22nd Black trans woman murdered in the United States in 2019.) But who is killing these women, and why?

“I think a lot of cis people assume it’s random hate crimes, like roving bands of Nazis running around murdering people,” says Paige Kreisman, a political organizer who came in second in the May Democratic primary for state rep in her Southeast Portland district. (Kreisman, like every other woman in this article, is trans.) “But statistically speaking, the most common perpetrators of violence against trans women are domestic partners.”

It’s true that strangers sometimes kill trans women; in February, for example, a Puerto Rican woman named Alexa Negrón Luciano was murdered after using the women’s restroom at a fast food restaurant. But advocates estimate half of all trans killings are carried out by partners or dates.

Last December, 17-year-old Nikki Kuhnhausen was found dead in Vancouver, Washington, after meeting up with a man for a sexual encounter in June. The 25-year-old arrested for Kuhnhausen’s death “became enraged at the realization he had engaged in sexual contact” with a trans girl, per the police detective’s report, and allegedly strangled Kuhnhausen.

This scenario—assaulting a romantic or sexual partner after learning they are trans—is a recognized legal defense strategy, known as “trans panic defense.” Of course, trans women are not under any obligation, legal or otherwise, to disclose their assigned gender at birth to their sexual partners. But beyond that, assailants are often aware their partner is trans; claiming “trans panic” can be a way for them to avoid admitting they were knowingly attracted to a trans woman.

It’s a lot of survival-based crimes, such as sex work, panhandling/soliciting, squatting, low-level theft, or drug sales, because there are a lot of intersecting systems of oppression that put trans people in vulnerable situations,” explains Kreisman. “Three out of 10 trans people have been houseless in our lifetimes, and houseless people are subject to much more police harassment and targeting, so that leads to high rates of incarceration.—Paige Kreisman

“Most of the trans women I know who’ve been murdered by men are murdered by men they were dating who knew they were trans,” Portland activist Alyssa Pariah shared at a 2019 speaking event at Portland State University. “You’re dealing with secondhand transphobia—maybe someone in [his] life found out that the woman that [he’s] seeing and loving is trans, and it makes [him] nervous. And they’re killing our friends and family.”

Calling the police in the face of such violence is not a safe option for many trans people. Per the same NCTE survey, visibly trans people experience high levels of verbal harassment (20 percent) and physical or sexual attacks (6 percent) when interacting with police officers.Earlier this year, Washington became just the 10th state in the nation to outlaw the use of gay and trans panic defenses for homicide. In Oregon, meanwhile, trans panic defense is still legally admissible. And Kuhnhausen’s case, while extreme, is far from isolated; in a 2015 survey of trans people by the National Center for Transgender Equality, more than half of all respondents reported experiencing intimate partner violence in their lifetimes.

The United States prison system is yet another source of violence for trans people—particularly Black trans people, who have a nearly 50–50 chance of being incarcerated at some point in their lifetimes. “It’s a lot of survival-based crimes, such as sex work, panhandling/soliciting, squatting, low-level theft, or drug sales, because there are a lot of intersecting systems of oppression that put trans people in vulnerable situations,” explains Kreisman. “Three out of 10 trans people have been houseless in our lifetimes, and houseless people are subject to much more police harassment and targeting, so that leads to high rates of incarceration.”

In Oregon, 96 percent of incarcerated trans women are housed in men’s jails and prisons. Once imprisoned, trans people experience staggeringly high levels of physical assault, and are up to five times more likely than their cis peers to be sexually assaulted by staff and nine times more by fellow inmates. Activists like Pariah also draw attention to the stories of young trans women who have died while incarcerated. Since 2018, at least two female trans immigrants, Johana Medina Leon (25) and Roxana Hernandez (33), have died in ICE custody. And last year, 27-year-old Layleen Polanco died following an epileptic seizure while she was in solitary confinement after officers failed to complete routine checks and refrained from entering her cell despite her unresponsiveness and known medical history of epilepsy. She had been unable to post the $500 bail required to avoid jail time.

“Those are people who are just like me; they’re not different,” says Pariah, who was friends with Polanco. “And they’re dead, and I’m alive. So I’m feeling guilt about even still making it.”

Once trans women are released from prison, they have to contend with systemic violence and discrimination; accessing basic needs like safe housing, employment, and medical care is statistically more difficult for trans people than for their cis peers, and arrest records can make that struggle even harder. It all adds up to a community emergency for Kreisman, who entered politics with the hopes of addressing these systemic issues and others.

“There are real material manifestations of oppression that need to be dismantled,” she says, citing police violence, the prison industrial complex, for-profit private health care, and lack of shelter for houseless trans people as examples. “Putting your pronouns in your bio isn’t something that you need to expect a pat on the head for. We have a lot more important work to do that we need help with.”

Another Health Crisis: Violence Against Black Trans Women in Ameerica - 7/20/20

In 2017, Tiara Richmond—also known as Keke Collier—was fatally shot in Chicago at the age of 24, on the same street where two other transgender women were killed five years earlier.

In 2019, Titi Gulley, a 31-year-old Black trans woman experiencing homelessness, was killed in Portland. Her death was originally ruled a suicide, until her family found evidence that implied otherwise.

In June of 2020, Dominique Fells, a 27-year-old who loved fashion, was brutally murdered in Philadelphia. The search for her suspected killer is still ongoing. Fells is one of 13 Black trans women known to have been killed this year, although there are likely more that have gone unreported.

Over the past five years, 80% of transgender homicides were Black women, and less than half of those cases led to arrests.

The lives of trans women of color, and specifically Black trans women, are threatened every day by discrimination and hate crimes fueled by transphobia. Much of this discrimination is perpetuated by existing systems and policies, including the Trump Administration’s most recent amendment to the civil rights provision (Section 1557) of the Affordable Care Act, which removed anti-discrimination protections for many patients, including trans people. Black trans women make up 44% of all trans women with HIV, but many trans people go without the care they need because they fear mistreatment by doctors and other providers—something that is not uncommon for trans patients.

No one should be denied the health care services they need to survive. Beyond health care, trans people face discrimination and other barriers in employment, housing, and even bathroom access. How can someone thrive in a society that denies them basic rights, prohibiting them from reaching their full potential?

At the intersection of racism and transphobia, Black trans women disproportionately face traumatic or deadly violence, along with the discrimination they face in our social and financial systems. As a result, Black trans women face homelessness due to discrimination and harassment in the work place, and have high percentages of suicide attempts. Because of this violence and the hate thrown at trans people, the life expectancy for a Black trans woman is 35.

This crisis amplifies the consequences that discrimination, unequal access to safe and affordable health care, and other systemic inequities have on trans women of color as well as the LGBTQ community. The lives of Black trans women are ended tragically short, and for those women who were killed, often there is very little accountability or justice for their perpetrators. We can’t only care about the lives of trans people when their deaths or violent attacks go viral. We must address the systemic barriers and everyday violence encouraged by transphobic rhetoric in order to protect our communities and ensure everyone has the fair opportunity to live safe and healthy lives.

Philly’s surprising arrest rate in reported violence against trans women this year: 100% - 11/13/20

These kinds of cases are likely under-counted, however, thanks to a fraught relationship with police.

When Los Angeles police this week captured a suspect accused of murdering Dominique Rem’mie Fells, it marked the third arrest in as many cases of violence against Philadelphia Black trans women this year.

The 100% arrest rate is astonishing, experts say. Historically, it’s been more common for police to be violent toward trans people than to prioritize solving crimes committed against them.

“That’s very rare. That’s unheard of,” said Dr. Kevin Nadal, a psychology professor at the City University of New York who wrote a book called “Queering Law and Order.”

“Most violent acts against trans people end up being unsolved,” Nadal explained. “To hear a police department in Philadelphia has been successful in at least apprehending these suspects, that’s very surprising.”

Suspect Akhenaton Jones, accused of killing Fells and leaving her dismembered body on the banks of the Schuylkill River in June, was apprehended in California on Monday. Over the past few months, Philadelphia District Attorney Larry Krasner had already begun prosecuting suspects in connection with two other acts against local Black trans women in 2020: the murder of Mia Green and the brutal assault against Kendall Stephens.

“I think it’s clear that members of the transgender community who have long advocated for their right to live in dignity and peace are responsible for moving institutions like law enforcement to evolve in attitudes and practices,” said Krasner spokesperson Jane Roh.

Across the U.S., just 40% of murders against trans people have resulted in arrests over the past three year, according to data from lobbyist group Everytown for Gun Safety.

Part of the issue in prosecuting and solving these cases is thought to be reluctance on the part of victims to talk to law enforcement. Throughout American history, police have been violent toward trans people at higher rates than their cisgender peers. And in Pennsylvania, violence against the LGBTQ community still doesn’t count as a hate crime.

Kendall Stephens, who was brutally beaten inside her home in September, said trans people still deal with discrimination from rank-and-file police officers on a regular basis.

“Just about everyone who is trans that I know of has had some sort of negative, transphobic interaction with a police officer,” Stephens said.

Media attention matters, advocates say

The law enforcement attention Philadelphia is giving to acts of violence against trans people doesn’t exist nationwide.

Suspects were only arrested in about half these cases across the country, per an Everytown for Gun Safety study that identified 96 such situations in the past three years. A quarter remain unsolved with no leads, and only 1 in 10 have led to convictions.

Why has Philly seen more success of late? It’s hard to be sure, but Nadal, the CUNY professor, said the city’s progressive leadership is likely a huge help.

After Fells’ killing, Mayor Jim Kenney issued a statement calling violence against trans people “an epidemic.” DA Krasner has spoken out against recent killings, and hosted meetings with Stephens and other Black trans women to seek solutions. State Sen. Larry Farnese has re-introduced three bills to protect queer and trans Pennsylvanians from discrimination and hate crimes.

The Philadelphia Police Department has an LGBTQ liaison, and PPD rules mandate officers use the correct pronouns for victims of violence. That’s a major shift, as the relationship between trans people and law enforcement has long been adversarial.

In the mid-1900s, masquerade laws criminalized dressing in clothes that didn’t align with your sex. Police in New York used the informal “three-article rule” — meaning if a person wore three items of clothes considered belonging to the opposite gender, they could be arrested. These discriminatory laws culminated in the Stonewall Uprising, a series of riots led by Black trans women against police violence.

Trans people are still seven times more likely to experience physical violence when interacting with police compared to cisgender people. Misgendering and discrimination has been common for Stephens — so much so that she’s just decided not to report past assaults to police at all.

Though not the sort of systemic change we need, Nadal said, action like what’s been seen in Philly can make a perceptible difference.

“For a mayor to speak of Black trans lives, that’s something you won’t see in many cities or towns across the U.S.”

After recovering from the beating in her South Philly home, Stephens was invited to Harrisburg to advocate for more trans protections at the state level. She believes media attention played a big factor in the city’s 100% arrest rate this year.

“Rem’mie’s murder was so shockingly disturbing that people looked past the fact that she was transgender,” Stephens said. “It does seem like once a case gets a high level of media attention, everyone scrambles to get it right.”

The Problem: America’s Treatment of Black Trans Women

Violence against Black trans women has been accurately described as “a pandemic within a pandemic.” This summer, six Black trans women, all under the age of 32, were murdered in the span of nine days. Their deaths are part of a horrifying pattern; hate crimes against transgender and gender non-conforming individuals have been on the rise for years, with the number of murders in 2020 already almost surpassing that of 2019. Of the 26 victims so far this year and the 27 victims last year, the majority have been Black trans women under the age of 30.

Organizations like the Human Rights Campaign have released several reports detailing potential sources of this violence. In particular, Black trans women are killed at disproportionate rates because of “the intersections of racism, transphobia, sexism, biphobia and homophobia.” A report from CNN’s discussion with Kerith Conron, from the Williams Institute at UCLA, notes that the easiest answer to why Black trans women are disproportionately victims of fatal violence is that “[t]hey’re black, they’re transgender, and they’re women. Each of those distinct identities means that they face discrimination, prejudice and inequities on multiple fronts.”

The inequities and prejudice Black trans women face don’t just take the form of outright violence. A study by the National LGBTQ Task Force indicates that Black trans people have a 26% unemployment rate. That’s twice as high as the unemployment rate for transgender people of all racial and ethnic backgrounds, and four times as high as the unemployment rate in the general population. The study also found other shocking disparities; 41% of Black trans people have been homeless (more than five times the general population), 34% of Black trans people have household incomes less than $10,000 (more than eight times the general population), and nearly half of the Black trans population has attempted suicide. Although these statistics apply to the Black trans population in general and not to Black trans women specifically, based on how much more frequently Black trans women are killed, it’s reasonable to assume that they also experience these harms more frequently than other Black trans people.

In short, being a Black trans woman in America means you’re far more likely than most other people to experience serious roadblocks and harms, in the form of everything from extreme poverty to violent murder.

The Source: The Legal Landscape Impacting Societal Treatment of Black Trans Women

The way that American society treats Black trans women (ranging from callous disregard to outright hatred and violence) shouldn’t be shocking; in many ways, it is rooted and reflected in the American legal system.

Take the Trump Administration for an example. The current administration has exemplified a series of outright attacks against both racial/ethnic minorities and transgender people, the intersection of which leaves Black trans women subject to abuse at the hands of the law. Earlier this summer, the administration removed protections for transgender people in the realm of healthcare and health insurance. This change in policy allows healthcare providers/insurers to refuse treatment of transgender people, which will likely cause Black transgender women (who are already mistreated by the healthcare industry) to not seek out medical treatment, a significant problem at all times but especially so during an ongoing pandemic. The administration also implemented a highly controversial ban on transgender people serving in the military, a law which signaled the government’s negative view of trans individuals.

The current executive branch is not the only part of the American legal system that harms Black trans women. Up until the Supreme Court’s recent landmark decision Bostock, transgender people were not granted any federal antidiscrimination protections in the realm of employment. Not only that, but Congress has consistently failed to pass The Equality Act, a bill that would provide more sweeping protections for the entire LGBTQ+ community including requiring prisons to “house transgender individuals in facilities that match their gender identity,” a protection that is currently lacking and that leaves incarcerated transgender people 13 times more likely to experience sexual assault in prison. The patchwork of federal laws governing police brutality and misconduct also leaves Black trans women particularly vulnerable to violence at the hands of law enforcement.

State laws also leave Black trans women vulnerable, which acts as a form of state-sanctioned violence against them. 28 states have dangerous hate crime laws that don’t include protections for trans people. Several states also recognize the “trans panic defense,” a claim that a defendant was driven to violence due to their volatile emotional state after discovering that someone is transgender, as a valid legal defense for violence against Black trans women. Some states are so bad at protecting the rights of transgender people that online lists like “Where to Move in the United States if You’re Trans” have popped up; of course, if you’re among the 34% of Black trans people who are extremely poor, or the 41% of Black trans people who have experienced homelessness (the bulk of whom are likely Black trans women), moving to safer states is simply not possible.

The message of our federal and state governments failing to protect (and sometimes actively harming) Black trans women is terrifying: if the government doesn’t care about Black trans women, then citizens don’t have to care either. In other words, because the law treats Black trans women with disregard and violence, it gives individuals a free pass to do the same.

The Solution: Changing the Law and Changing Society

A cornerstone of the Black Lives Matter movement and the recent racial justice protests is “Black Trans Lives Matter,” an explicit recognition that even within a community of individuals who are in danger, the lives of Black trans people (especially women) are even more threatened. In fact, the Black Lives Matter movement has always relied heavily on the LGBTQ+ community, just like the LGBTQ+ community has depended on Black trans women like Marsha P. Johnson. The central focus of the Black Trans Lives Matter platform is a desire to change the treatment of Black trans people (especially women) in America by individuals and by the government.

Lawmakers would do well to listen to their voices.

A tangible way to increase the quality of life of Black trans women is to extend legal protections to them and to change the way that they are treated under the law. Some excellent starting points would be for the federal government to reinstate the healthcare protections that the Trump administration has gotten rid of, and for state governments to eliminate the trans panic defense. Extending protections to sex workers (or completely decriminalizing sex work), enacting stronger police brutality laws (or defunding the institution of policing), allowing incarcerated people to live in housing that matches their gender identity (or eliminating prisons entirely): these are all additional steps that the law could take to keep Black trans women safe.

By taking these steps, and others like them, lawmakers would do more than provide legal protections to Black trans women. They would also signal to society that Black trans women are valued, that their lives are to be celebrated just as much as everyone else’s. They would tell the American people unequivocally that Black trans women’s lives matter. Hopefully, societal attitudes toward Black trans women would then change too.

How to Talk to Your Kids About Sexuality and Sexual Orientation

Wondering how to have a conversation with your children about sexuality and sexual orientation?

These days, it's becoming more and more impossible to define "normal." That's a good thing. Go into nearly any classroom and you'll see the physical landscape of children looks vastly different than it did a generation ago. And that's before we even meet their parents. Most children these days have friends or neighbors whose families aren't exactly -- or, in some cases, remotely -- like their own.

There's not one "normal."

And yet, many of the messages children receive through pop culture -- whether it's animated films and television shows, music, or books -- continue to enforce one kind of "standard" romantic relationship, and that's the one between a man and a woman. Many parents question how, and when, to talk to their kids about sexuality, and the fact that despite this, there's not one "normal."

Some people -- particularly proponents of "don't say gay" legislation in states like Missouri and Tennessee, which aims to forbid public schools from mentioning that homosexuality exists at all -- argue that kids are too young to learn about sex. But talking about gay love needn't include a lesson in the mechanics of sex, gay or otherwise. Instead, it's a conversation about what it means to have love and friendship and respect for someone else -- all those things that you want them to understand about being good people. It's a conversation that's only awkward if you make it awkward.

8-year-old Ned first met his parents' gay friends Brett and Carl when he was three years old. The talk Ned's mother, Alice, had with Ned preceding their visit was less a discussion than a check-in and went something like: "'Brett and Carl are a couple, just like Mommy and Daddy, and love each other very much.'" Later, Ned asked some specific questions -- did they sleep in the same bed, like Mommy and Daddy? Did they kiss goodnight? -- and Alice always answered honestly, and age-appropriately. Ned wasn't old enough to have a discussion about how sex works, so she saved that for later. But it was perfectly normal to talk to him about how people in a couple support and love one another, and all the other non-sexual things that make gay love no different from straight love.

Helping encourage this creation of a new normal extends beyond sexuality.

For most children, being "different" in any sort of way is undesirable. But the more we talk about our own differences and others', the more "normal" they become, and the less undesirable they feel. When talking to your kids about their gay friends, neighbors, or relatives; their friends' gay parents; or your own sexuality, the most important thing to do is keep dialogue open and to keep it light. Sexuality is a big deal. But the principles are the same as any other discussion you'll have with them about growing up right: Practice kindness and love and treat others as you'd like to be treated. Plain and simple.

Singular 'They' in Grammar

Glossary of grammatical and rhetorical terms

In English grammar, singular "they" is the use of the pronoun they, them, or their to refer to a singular noun or to certain indefinite pronouns (such as anybody or everyone). Also called epicene "they" and unisex "they."

Though strict prescriptive grammarians regard the singular they as a grammatical error, it has been in widespread use for several centuries. Singular they appears in the writings of Chaucer, Shakespeare, Austen, Woolf, and many other major English authors.

In January 2016, the American Dialect Society chose the gender-neutral singular they as its Word of the Year: "They was recognized by the society for its emerging use as a pronoun to refer to a known person, often as a conscious choice by a person rejecting the traditional gender binary of he and she" (American Dialect Society press release, January 8, 2016).


  • "When a person talks too much, they learn little." (Duncan Hines, Lodging for a Night, 1938)
  • "If anybody wants their admission fee back, they can get it at the door." ("Fiddler's Dram." Spooky South: Tales of Hauntings, Strange Happenings, and Other Local Lore, retold by S. E. Schlosser. Globe Pequot, 2004)
  • "She admired the fullness of the dirty net curtains, opened every drawer and cupboard, and, when she found the Gideon's Bible, said, 'Somebody's left their book behind.'" (Sue Townsend, Adrian Mole and the Weapons of Mass Destruction. Lily Broadway Productions, 2004)
  • "She kept her head and kicked her shoes off, as everybody ought to do who falls into deep water in their clothes." (C.S. Lewis, Voyage of the Dawn-Treader, 1952)
  • "I know when I like a person directly I see them!" (Virginia Woolf, The Voyage Out, 1915)
  • "'A person can't help their birth,' Rosalind replied with great liberality." (William Makepeace Thackeray, Vanity Fair, 1848)

Singular They and Agreement

"Examples of semantically singular they are given in [52]:

  • [52i] Nobody in their right mind would do a thing like that.
  • [52ii] Everyone has told me they think I made the right decision.
  • [53iii] We need a manager who is reasonably flexible in their approach.
  • [52iv] In that case the husband or the wife will have to give up their seat on the board.

Notice that this special interpretation of they doesn't affect verb agreement: we have they think (3rd plural) in [ii], not *they thinks (3rd singular). Nonetheless, they can be interpreted as if it were 3rd person singular, with human denotation and unspecified gender." (Rodney Huddleston and Geoffrey K. Pullum, A Student's Introduction to English Grammar. Cambridge University Press, 2005)

The Growing Acceptance of Singular They

"The general hesitancy of grammarians towards accepting singular they is not actually matched by many of their academic colleagues who have researched the usage and its distribution (e.g. Bodine 1075; Whitley 1978; Jochnowitz 1982; Abbot 1984; Wales 1984b). Nor indeed is it matched by the lay native speakers of standard English, who show an overwhelming preference for it in contemporary spoken English, non-formal written English and an ever-widening spread of non-formal written registers, from journalism to administration and academic writing. . . . Singular they, in fact, has been well established in informal usage for centuries; until prescriptive grammarians decreed it was grammatically 'incorrect,' and so outlawed it, effectively, from (public) written discourse. The OED and Jespersen (1914) reveal, for example, that right from the time of the introduction of the indefinite pronouns into the language in their present form in the Late Middle English period, the option involving they has been in common use." (Katie Wales, Personal Pronouns in Present-Day English. Cambridge University Press, 1996)

'The Only Sensible Solution'

"His or her is clumsy, especially upon repetition, and his is as inaccurate with respect to grammatical gender as they is to number. Invented alternatives never take hold. Singular they already exists; it has the advantage that most people already use it.

"If it is as old as Chaucer, what's new? The Washington Post’s style editor, Bill Walsh, has called it 'the only sensible solution' to the gap in English’s pronouns, changing his newspaper's style book in 2015. But it was also the rise in the use of they as a pronoun for someone who does not want to use he or she. Facebook began already in 2014 allowing people to choose they as their preferred pronoun ('Wish them a happy birthday!').

Transgender stories, from The Danish Girl, a hit movie, to Caitlyn Jenner, an Olympic athlete who has become the world’s most famous trans woman, were big in 2015. But such people prefer their post-transition pronouns: he or she as desired. They is for those who prefer neither. Some non-binary people are transgender, but not all non-binary people identify as trans. But the very idea of 'non-binary' language with regard to gender annoys and even angers many people.

"Who knew a thousand-year-old pronoun could be so controversial?" (Prospero, "Why 2015’s Word of the Year Is Rather Singular." The Economist, January 15, 2016).

Origin of the Concept of the Gender-Neutral Masculine Pronoun

"[I]t was [Ann] Fisher [author of A New Grammar, 1745] who promoted the convention of using he, him and his as pronouns to cover general statements irrespective of gender, such as 'Everyone has his quirks.' To be precise, she says that 'The Masculine Person answers to the general, Any person who knows what he says.' This idea caught on...The convention was bolstered by an Act of Parliament in 1850: In order to simplify the language used in other Acts, it was decreed that the masculine pronoun be understood to include all. The obvious objection to this—obvious now, even if it was not obvious then—is that it makes [all who are not men] politically invisible." (Henry Hitchings, The Language Wars: A History of Proper English. Macmillan, 2011)

After 2 Trans Women Are Killed In 2 Weeks, Activists Beg City To Take Crimes More Seriously — And To Stop Misgendering Victims

Tyianna Alexander, 28, was shot and killed less than two weeks after her friend, Courtney Eshay Key, was killed on Christmas Day.

The two became inseparable while attending William Rainey Harper High School in West Englewood. They shared everything and came out as transgender women together as teenagers.

“We went to school together, hung out together, grew up together and even transitioned together,” Bowman said. “Tyianna was my best friend since even before day one. We used to pick out outfits and show each other how to do hair and makeup.

“She was creative and artistic, so fashion came second-nature to her, and she’d teach me how to put my clothes together so I could look presentable.”

Alexander, 28, was killed Jan. 6 when an unknown man in a silver car shot her and a 31-year-old man in the 800 block of West 75th Street, according to Chicago police.

Alexander was at least the second Black transgender woman to be killed in Chicago within a month. On Christmas Day, Courtney “Eshay” Key, 25, was gunned down in the 900 block of East 82nd Street while heading to her mom’s house, Key’s friends and police said.

The shootings remain under investigation and no arrests have been made, police said.

Friends, family and transgender activists have questioned whether the two women were targets of anti-trans hate crimes, attacks that are part of another “deadly pandemic” affecting Black trans women everywhere.

Adding to the trauma of losing loved ones, friends and family often grapple with police misgendering trans victims in investigations and city leaders giving little attention to the issue.

At least three other transgender women have been killed in Chicago within the past two years:

  • Selena Reyes-Hernandez, 37, on May 31in Marquette Park.
  • Ciara Minaj Carter Frazier, 31, on Oct. 2, 2018.
  • Dejanay Stanton, 24, on Aug. 30, 2018.

“This is a constant thing that we deal with as a transgender community,” said LaSaia Wade, executive director of the Brave Space Alliance, a Black- and transgender-led organization on the South Side.

But violence against transgender people is a national issue. Murders of trans people were at an all-time high in 2020, according to a report by the Human Rights Campaign.

Throughout past year, 37 trans and gender-nonconforming people were killed across the United States.

“This isn’t the first time we’ve had to bury a member of the community, and it most likely is not going to be the last time, which is sad,” Wade said.

Bowman said having Alexander by her side while she transitioned was “a blessing.”

“She was so supportive and someone I could go through anything with, so I feel lost now that she’s gone,” Bowman said, holding back tears. “She was more than a best friend. She was my sister.”

Alexander was involved in the Chicago Youth Dance Coalition, an after-school dance program where she learned footwork and other Chicago dance styles. Bowman was Alexander’s biggest cheerleader and would support her from the audience at every dance showcase or from the sidelines of the Bud Billiken Parade.

“She loved to dance, and she would teach all her dances to me,” Bowman said. “That’s how I learned to vogue. We would go to balls together and I would just watch her voguing.”

Alexander also had “a natural eye for beauty” and taught Bowman how to do her hair when they transitioned.

“I would call her ‘Barbie’ because she loved to look pretty,” Bowman said. “My best friend was glammed up and she’d stay done. If you look at all her pictures, she’s beautiful.”

Alexander’s energy was contagious, Bowman said, and she uplifted people with compliments and good vibes everywhere she went.

“When I tell you, Barbie was an all-around genuine person,” Bowman said. “She was a blessing to everyone she met and would leave people in good spirits everywhere she went.”

Alexander was “the life of every party,” said her auntie, Courtney McKinney.

“She’s always jiving,” McKinney said. “First she’s dancing over here, now she’s dancing over there. She’s keeping the crowd motivated is what she’s doing.”

“What’s the tea?” Alexander would often say, asking her friends what their plans were for the night. But she was really just looking for the nearest dance floor.

“You always knew when Tyianna entered the room because she’d come through dancing,” Bowman said.

People close to Key called her Big E or Big Shay, nicknames playing off her middle name, Eshay, best friend Red Montana said.

She was always with her group of friends, who called themselves “The Wigs.”

“We were a family of friendships,” Montana said. “We were more than friends — we were a sisterhood, and each one of us brought our own flavor to the group. Big E was always crazy funny and crazy fun to be around. She was so outgoing and just a true free spirit.”

Montana is a rapper and said Key loved to be her hype woman. The two loved Nicki Minaj and would take turns freestyling over her songs.

“She was so supportive of my rapping and wanted to be a video girl in my music videos,” Montana said. “She was an excellent hype woman.”

Key and Montana met in 2012 while attending South Shore High School, Montana said. The two would go on walks to 83rd Street and Cottage Grove Avenue, where they’d buy ribs from Uncle John’s BBQ and treats from Dat Donut.

“We’d pick up the food, get in the house, take off our wigs and jump in the bed to just watch TV and relax all day,” Montana said.

Key loved soul food, said Nathaniel Porter, 25, another close friend.

“Her favorite thing to do was come over to friends’ houses and have us cook for her,” Porter said. “She liked quality time with baked macaroni, candied yams and pot roast.”

Nathaniel Porter’s favorite memory of Courtney Eshay Key was shopping downtown at the Gucci store and then taking photos by the water fountain.

One of his favorite memories with Key was going shopping Downtown together and spending the entire day walking around the city and taking photos.

“It was a chill, very fun moment to just hang out with her. The entire day was nothing but fun, and just exemplifies what it was like being around [Key],” Porter said.

As a friend, Porter said Key was “fiercely loyal” and he could depend on her for anything.

“I’m just so devastated because she was my person I could go to with anything and she’d be understanding and wouldn’t judge,” Porter said. “I shared so many secrets with her that I’ll never share with anybody else in my life. It’s hard.”

Porter and Montana said they planned to honor Key’s life by “keeping her name alive.”

“Any time, any event, Courtney’s name will be there,” Montana said. “If I’m at a party, I’ll have a shirt with her name on it, and if I ever have a larger platform than I have now, I will scream Courtney’s name at the top of my lungs.”

Activists ‘At A Standstill’ With Police Over Misgendering Trans Victims

Key was misgendered by Chicago police officials and in subsequent news stories in the initial reports surrounding her death.

“I was outraged,” Porter said. “Courtney wore nails, lashes, wigs and her hair under her wigs was braided, so it’s really messed up they would just misgender her. It’s dehumanizing.”

When someone is transgender, Chicago police are directed by their general orders to classify the person using the gender listed on their government-issued ID card. Exceptions can be made if the person has undergone a gender-affirming surgery

There are provisions guiding officers to use a person’s correct pronouns and name even if it doesn’t match a government ID. But that is incumbent upon a trans person giving police that information, which likely is not possible if they’re gravely hurt. Those advisories were last updated in 2015.

CPD has been working to revise its orders on how to interact with transgender, intersex or gender nonconforming people since 2019, according to a department spokesperson. The revision is in its final stages and will be presented for public comment within the next few weeks, police said.

“A major change in the new policy includes officers now being required to document an individual’s name and gender based on how they identify, express or request,” the spokesperson said in a statement.

Porter said he didn’t think Key’s ID had been changed, but police should have known she was transgender. Additionally, friends and family have come forward to police to inform them Key was a transgender woman, but the department’s media briefing on the shooting still hasn’t been updated to reflect her correct gender.

“At the end of the day, they saw how she was dressed and knew which house to come to, so there are no excuses,” Montana said.

Wade, who has advocated for transgender victims of violence for years through the Brave Space Alliance, said she’s “at a standstill” with local police and has “given up on hoping for them to stop misgendering us.”

“There’s a refusal to respect the fact that a trans woman’s community, mother and friends are transgender, and until our police face repercussions for misgendering us, it’s not going to stop,” Wade said. “When you misgender these women, you’re not giving trans women the dignity of being a human being, even in their death.”

Block Club filed a Freedom of Information Act request for police reports in Key and Alexander’s fatal shootings to determine how officers on scene initially reported their genders. Chicago police asked for more time to respond and have not yet provided the documents. A media briefing about Alexander’s fatal shooting did not specify her gender.

In a statement, a CPD spokesperson said the department “does not tolerate hatred or bigotry of any kind within this city.”

“Crimes stemming from discrimination based on race, nationality, religion, sexual orientation, gender, physical disability or mental disability are thoroughly investigated by the Department’s Civil Rights Unit in conjunction with the Bureau of Detectives,” the statement read.

“Additionally, we are continually working to strengthen our relationship with the LGBTQ+ community to ensure our residents feel safe and protected within this city.”

Wade called on Mayor Lori Lightfoot to “enter the conversation” to mandate Chicago police use correct genders for trans people and address root causes of anti-trans violence, such as hatred and housing or financial instability.

Asked for comment, the Mayor’s Office deferred to Chicago Police.

“The broader issue is that the city and state need to be allocating more funds towards trans-led work and services, rather than just the gay- and white-led LGBTQ organizations,” Wade said. “Improving the quality of life for Black and Brown trans women will help stop this violence.”

Jake Wittich is a Report for America corps member covering Lakeview, Lincoln Park and LGBTQ communities across the city for Block Club Chicago.

Violence against trans women: How many more? - 10/12/20

During their freshman year of high school, Amber Va unknowingly embarked on a new life journey.

When they learned about Jazz Jennings and Caitlyn Jenner on the news, they realized they did not identify with the gender they were assigned at birth.

Va, a second-year women and gender sexuality studies major at Long Beach State, was assigned male at birth and now identifies as a nonbinary trans femme – someone who identifies with no gender, but expresses themselves as feminine as possible.

In 2019, with the help of mentors from the Gay Straight Alliance Network, Va was able to legally change their name and begin hormone treatment.

While the LGBTQ community is becoming more accepted, there is still a high rate of hate crimes against trans and nonbinary individuals. They are more likely to experience violence than their cisgender counterparts.

According to the Long Beach Police Department’s hate crime victim statistics, there have been reported hate crimes committed against the LGBTQ community every year from 2010 to 2019. Graph by Alejandro Vasquez

In 2020, there have been 31 transgender or gender nonconforming individuals that have been fatally shot or killed in a violent manner.

Toxic masculinity is an issue that trans and gender nonconforming individuals face that can result in harm towards them, according to a blog post by the University of Alabama at Birmingham.

Recently, a video was posted on Youtube about an attack on three trans women in Hollywood.

“When I read about this, it puts me in panic mode,” Va said. “My heart aches that someone would do this to our community. To me, it shows that there will be some people who won’t accept change in our society.”

According to the Human Rights Campaign Foundation, more than 130 transgender and gender-expansive individuals have been killed in the United States since 2013, when these types of cases began to be recorded.

In 2019, 91% of the reported murders were Black individuals, and 81% percent were under the age of 30.

“From looking at these statistics, I live in fear on a daily basis, but I don’t let it get to me,” Va said. “Having support from the community, my family, my friends and my partner help me get through the day.”

According to Mallery Robinson, ignorance and misinformation about the trans and nonbinary community is one of the leading causes of violent actions made against them. Oftentimes, individuals are met with mockery or made fun of due to their gender identity.

Robinson has been an engagement specialist and service navigator for the transgender health program at the Long Beach LGBTQ Center for a year and a half. She encourages individuals that identify with the trans and nonbinary community to contact her through the Trans Health Department of the Long Beach LGBTQ Center for assistance.

“So, you have all this stuff that’s going out into the world that scares people,” Robinson said. “Unfortunately, all that fear and phobia lead to people wanting to not feel afraid, then want to go and hurt that community. My community.”

A research study done by Transrespect Versus Transphobia Worldwide between 2008 and 2016 reported that there were 2,343 murders of trans and gender-diverse individuals worldwide. Of those individuals, 46% were between the ages of 20 and 29.

Black and Latina trans women who are in the sex worker industry are more vulnerable to violence because of laws and policies that criminalize sex work. According to the World Health Organization, “sex workers are often reluctant to report violent incidents to the police for fear of police retribution or of being prosecuted for engaging in sex work.”

“A lot of times bystanders will often overlook what is happening,” Robinson said. “Please, don’t just pull out your camera and start filming. Actually call the authorities. Be willing to assist if you can, even if that’s pushing that person off.”

According to Robinson, some ways that transwomen of color can protect themselves are by trusting their guts, taking defense classes and being aware of their surroundings.

“Use those spidey-senses,” Robinson said. “If it doesn’t feel right, it’s definitely not.”

Cereza Alcántara, a sex worker and self-identified Latinx trans woman, said she takes safety precautions when she goes out.

“I always carry a pocket knife with me and share my location with at least two people if I’m going out alone,” Alcántara said. “In my experience, I do think there are a lot more risks involved.”

Alcántara said online services are safer than escorting because she has more control over what gets published online. She said that while the block button is easily available, some people still find her other profiles or make spam accounts to contact her and see her content.

She said she learned from other sex workers that a safer process for escorting involves requiring payment upfront, meeting at a public location then going where the services will take place and sharing her location.

“I would say the violence I have faced is more so implicit,” Alcántara said. “Being in this line of work we do get fetishized and slurs are bound to come up. Sometimes I do not have the energy to educate grown men on how to be a decent person to trans folks, so I block.”

Alcántara said she sometimes gets red flags from clients.

“Most recently, I had a client tell me that he wants to get me drunk so he could have his way with me,” Alcántara said. “Needless to say, I blocked and moved on.”

Since they started working at the Long Beach LGBTQ Center two years ago, Jaye Prado, lead legal services advocate, noticed that one of the most requested services is the name and gender change petition.

“It is a big part of my work,” Prado said. “I realized that this is a huge thing for transgender people, specifically transwomen, to get identity documents to match their gender identity. It’s such a huge deal when being in public spaces.”

Name and gender changes give more confidence to transgender people to live more authentically and can help in reducing some of the discrimination they face.

“We know that the more intersections of oppressed identities that someone holds, the more likely they are to experience some form of violence,” Prado said. “LGBTQ people are disproportionately impacted by violence, specifically transgender communities.”

According to the 2015 National Transgender Survey Report, 54% of transgender people experienced some form of domestic violence, and nearly one in 10 were physically attacked because of their gender identity.

In partnership with District 2, the Long Beach LGBTQ Center will have a Black Lives Matter memorial to remember their fallen members. Their goal is for their trans and nonbinary members to feel safe and secure in the environment.

“We need to remember those victims—memorialize them, remember that they existed,” Robinson said.

New Study Reveals Shocking Rates of Attempted Suicide Among Trans Adolescents - 9/12/21

Harrowing statistics from a study recently published by the American Academy of Pediatrics revealed alarming levels of attempted suicide among transgender youth -- with the highest rates among transgender boys and non-binary youth. The findings emphasize the urgency of building welcoming and safe communities for LGBTQ young people, particularly for transgender youth.

More than half of transgender male teens who participated in the survey reported attempting suicide in their lifetime, while 29.9 percent of transgender female teens said they attempted suicide. Among non-binary youth, 41.8 percent of respondents stated that they had attempted suicide at some point in their lives.

Many transgender young people experience family rejection, bullying and harassment, or feel unsafe for simply being who they are - all of which can be added risk factors for suicide. Earlier this year, HRC released its 2018 LGBTQ Youth Report, which detailed similarly alarming experiences -- but also significant perseverance among LGBTQ young people in the face of daunting challenges.

There are steps that can be taken to help prevent this tragedy.

HRC Foundation’s Welcoming Schools program provides specific guidance to parents, teachers and the wider community for preventing anti-LGBTQ bullying and aggression in schools. This can be as simple as responding appropriately to anti-LGBTQ comments in the classroom, or encouraging educators to promote inclusivity and diversity in their lesson plans.

Parents and families can start by learning the facts and educating themselves about issues that impact LGBTQ youth. Whether or not families have openly LGBTQ children, it is vital to make home a safe and affirming space for all identities.

If you or someone you know may be at risk of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. If you’re a young LGBTQ person and need to talk to someone, call The Trevor Project’s 24-hour crisis hotline for youth at 1-866-488-7386. If you are a transgender person of any age, call the Trans Lifeline at 877-565-8860 or Crisis Text Line text SOS to 741741

Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972–2017) (Abridged)


This study explored the overall suicide death rate, the incidence over time, and the stage in transition where suicide deaths were observed in transgender people.


Out of 5107 trans women (median age at first visit 28 years, median follow-up time 10 years) and 3156 trans men (median age at first visit 20 years, median follow-up time 5 years), 41 trans women and 8 trans men died by suicide. In trans women, suicide deaths decreased over time, while it did not change in trans men. Of all suicide deaths, 14 people were no longer in treatment, 35 were in treatment in the previous two years. The mean number of suicides in the years 2013–2017 was higher in the trans population compared with the Dutch population.


We observed no increase in suicide death risk over time and even a decrease in suicide death risk in trans women. However, the suicide risk in transgender people is higher than in the general population and seems to occur during every stage of transitioning. It is important to have specific attention for suicide risk in the counseling of this population and in providing suicide prevention programs.

Significant outcomes

  • Suicide death risk in trans people did not increase over time.
  • Suicide deaths occurred during every stage of transitioning.
  • Suicide death risk is higher in trans people than in the general population.


The characteristics of the study population are shown in Table 1. In total, 8263 people attended the gender identity clinic, of which 5107 were trans women (median age at first visit 28 years, range 4 to 81 years) and 3156 were trans men (median age at first visit 20 years, range 4 to 73 years). The median follow-up time was 7.5 years (range 0.0–45.5 years), which was longer in trans women (10.2 years, range 0.0–45.5 years) than in trans men (4.8 years, range 0.0–45.5 years). The total follow-up time was 92 227 person years (64 287 in trans women and 27 940 in trans men).

Table 1: Characteristics of the study population (A) and the people who died by suicide (B)

Trans women
Trans men


Number of people


Age at first visit, year

25 (4–81)
28 (4–81)
20 (4–73)

Follow-up time, year

7.5 (0.0–45.5)
10.2 (0.0–45.5)
4.8 (0.0–45.5)


Number of suicides

49 (0.6%)
41 (0.8%)
8 (0.3%)

Age at first visit, year

31 (15–59)
31 (15–58)
21 (16–59)

Age at time of suicide, year

41 (18–66)
41 (18–66)
36 (21–60)

Follow-up time, year

6.7 (0.6–32.7)
6.7 (0.6–32.7)
6.7 (0.6–23.1)

Time between start hormones and suicide, year

6.4 (0.4–32.5) n = 42
6.1 (0.4–32.5) n =35
6.9 (3.7–23.1) n =7

Data are shown as number or median (range).

Forty-nine people died by suicide: 41 trans women (0.8%) and 8 trans men (0.3%), which is 64 per 100 000 person years in trans women and 29 per 100 000 person years in trans men. The median follow-up time between first visit and suicide death was 6.7 years (range 0.6 to 32.7 years) in trans women and 6.7 years (range 0.6 to 23.1 years) in trans men. Trans women had a higher overall suicide death risk than trans men (per year: HR 2.26, 95% CI 1.06–4.82). Four suicide deaths occurred in individuals who were referred to the clinic before the age of 18 (0.2%), which is a lower risk than in adults (0.7%, P = 0.010).

The course of number of people at risk and the number of people who died by suicide over the years is shown in Fig. 1. Overall suicide deaths did not increase over the years: HR per year 0.97 (95% CI 0.94–1.00). In trans women, suicide death rates decreased slightly over time (per year: HR 0.96, 95% CI 0.93–0.99), while it did not change in trans men (per year: HR 1.10, 95% CI 0.97–1.25). Adjustment for age at the first visit did not change these numbers.

As the median follow-up time between first visit and suicide death was 6.7 years, subgroup analyses were performed in those who had their first visit before 2011. This did not change the outcomes: trans women (n = 3115) HR 0.94, 95% CI 0.91–0.98; trans men (n = 1269) HR 1.02, 95% CI 0.90–1.16).

Of the 49 people who died by suicide, 35 had a face-to-face contact with the endocrinologist or psychologist of the gender identity clinic in the previous two years, while the other 14 people were no longer in active counseling with the clinic. Sixteen of the 35 people who recently had visited the clinic, only came for a medical check-up, as they were postsurgery (vaginoplasty or phalloplasty). Two people were in the surgery trajectory, and 17 were still in the diagnostic or hormonal phase at time of suicide. The transition phases separately for trans women and trans men who died by suicide are shown in Table 2.

Table 2 The occurrence of suicide deaths distinguished for transition stage, and trans women or trans men

Total (n = 49)
Trans women (n = 41)
Trans men (n = 8)

In active counseling


In diagnostic or hormonal phase


In surgical phase


Only medical follow-up care


No active counseling


Data are shown as number. In active counseling is defined as a face-to-face contact with the endocrinologist or psychologist of the gender identity clinic in the previous two years.

The mean number of suicides in the years 2013–2017 was higher in the trans population (40 per 100 000 person years; 43 per 100 000 trans women and 34 per 100 000 trans men) compared with the Dutch population in this time frame (11 per 100 000 person years; 15 per 100 00 registered men and 7 per 100 000 registered women) (28).

Transgender people and suicide

Transgender (trans) people face unique stressors, including the stress some trans people experience when their gender identity is not affirmed. Trans people also experience higher rates of discrimination and harassment than their cisgender counterparts and, as a result, experience poorer mental health outcomes. They are also at a greater risk for suicide as they are twice as likely to think about and attempt suicide than LGB people (Haas et al., 2011; McNeill et al., 2017; Irwin et al., 2014).

However, as with sexual orientation, gender identity is not recorded on death certificates, so the exact number of the trans people who die by suicide is hard to determine.

Consequently, there have been little data and research on gender identity, but this is starting to change (McNeill et al., 2017).


Transgender (trans) is an umbrella term that represents a wide range of gender identities and expressions. Trans people do not identify either fully or partially with the gender associated with their assigned sex at birth (Canadian Federation of Students, 2017).

Gender identity refers to a personal conception of one’s place on the gender spectrum; the gender that one identifies as may be the same or different from their birth assigned sex.

Alternative terms to transgender include: non-binary, genderqueer and gender fluid (Veale et al., 2015).

Language is very important when discussing gender: it’s helpful to know how someone self-identifies in order to honour their self-expression and create a safe environment in which they can express themselves.

Things to know about language. Trans people may:

  • have a fluid gender identity, meaning that their gender expression may fluctuate along with the label with which they identify
  • use more than one identity label, for example, “trans woman” and “genderqueer” (McNeill et al., 2017, p.2)
  • choose non-binary labels such as “bi-gender,” “androgyne” and “polygender”
  • not define a gender at all (this is called “neutrois”) (Bailey et al., 2014).


  • Approximately 0.5% of the population is transgender (Bauer et al., 2015a)
  • 22-43% of transgender people have attempted suicide in their lifetime
  • Over 10% of transgender people report recently attempting suicide (within the previous year) (Bauer et al., 2015a)
  • 2/3 of trans youth report recent self-harm (within the previous year) (Veal et al., 2015)
  • Trans people are 2 times more likely to think about and attempt suicide than lesbian, gay or bisexual people (Irwin et al., 2014).

Are trans people more at-risk of suicide?

Trans people are more at risk of suicide than heterosexual people and lesbian, gay, and bisexual people. Studies and surveys have shown many transgender people have thought about and attempted suicide, and previous suicidal behaviours such as these are the most reliable indicators of future suicide risk (Suicide Prevention Resource Centre [SPRC], 2008).

Transgender people also experience mental illness at significantly higher rates than the general population. This heightened risk is primarily due to the fact that transgender people face unique stressors, including stress from being part of a minority group, as well as stress related to not identifying with one’s biological sex. If left untreated, these mental health disorders can also be indicators for suicide risk.

Risk Factors

Certain factors can place people at a higher risk for suicide than others. These are some risk factors that affect the transgender population particularly:

  • Distress related to a conflict between one’s physical or assigned gender and the gender with which they identify
  • Stress related to fear of transitioning, including the potential backlash and life disruption, as well as considering the risks and sometimes lengthy time period involved
  • Experience of discrimination (transphobia) in the form of physical or verbal harassment, physical or sexual assault
  • Lack of support from parents and other family members
  • Institutional prejudice manifesting as laws and policies which create inequalities and/or fail to provide protection from discrimination
  • Mental illness (including depression, anxiety)
  • Excessive alcohol and/or drug use
  • Stigma
  • Isolation from conventional society
  • Access to lethal means (e.g. firearms, prescription drugs)
  • Homelessness

(Bailey et al., 2014; Haas et al., 2011; SPRC, 2008).

Warning signs for those at risk

Some warning signs require more immediate action than others. If someone is exhibiting the following warning signs, call 9-1-1:

  • Talking about wanting to die or kill oneself; or
  • Looking for a way to kill oneself or already having a plan (American Association of Suicidology, 2018).

Homeless trans youth

LGBTQ youth are greatly overrepresented in the homeless youth population in North America (Abramovich, 2012); about 30% of homeless youth identify as LGBTQ compared to 5 to 10% of non-homeless youth. The shelter system (which houses homeless youth intermittently) should be accountable for fostering safe spaces for all youth, irrespective of sexual or gender identity. Staff should be trained on “issues relating to LGBTQ youth culture, terminology, needs, homophobia and transphobia” (Abramovich, 2012, p.47).

Transitioning as both protective and risk factor

The decision to medically transition to the gender with which one identifies can be stressful and may place someone more at risk for suicide. However, studies show that once a transition is completed, it does have beneficial effects.

A survey of trans people in the UK found that a completed medical transition was shown to greatly reduce rates of suicidal ideation and attempts, in contrast to those at other stages of transition (imminently transitioning or beginning transition). 67% of transitioning people thought more about suicide before transitioning whereas only 3% thought about suicide more after their transition (Bailey et al., 2014).

While some trans people undergo medical interventions like hormone therapy or gender reassignment surgery, others may not, choosing to socially transition by changing their name and/or gender presentation.

"Choosing one’s own name has positive effects on a trans person’s mental health. The study showed that “having even one context in which a chosen name could be used was associated with a 29% decrease in suicidal thoughts” (Russell, et al, 2018)."

Protective Factors

  • Membership in Gay-Straight Alliance (GSA) or other school supports
  • Supportive and strong relationships with family and friends
  • Completed medical transition (if transition is desired)
  • Effective mental health care and health care
  • Connection to trans community
  • Pride in one’s own gender identity
  • Self-awareness and acceptance

(Bailey et al., 2014; Bauer et al., 2015; Haas et al., 2011; SPRC, 2008).

Transgender bullying prevention in schools

Schools need to play an active role in ending transgender harassment and discrimination, and in the past few years, many Canadian schools have integrated policies and programs to ensure LGBTQ students feel safe.

  • Safe-school policies and procedures specifically addressing transphobia

These policies create an environment where trans as well as lesbian, gay, bisexual and questioning (LGBTQ) students feel safer, more accepted, and more attached to their schools. In schools where these policies are in place, harassment of LGBTQ students is reduced, and in the instances of harassment, LGBTQ students are more likely to report the harassment to school staff and staff is more likely to intervene.

  • Policies supported from the division-level to the individual school.

Policies supported from all levels of the school system are most effective as staff and students realize the policies have institutional-wide endorsement and are actively enforced.

  • Support for the efforts of students to start Gay-Straight Alliance clubs (GSAs).

GSAs help encourage solidarity amongst a larger group of the student population; LGB students know they are supported by their straight peers (Saewyc et al., 2014; Egale Canada, 2011).

As an example, the Alberta government passed legislation-Bill 24—which strengthens rules around gay-straight alliances in schools. The law makes it more difficult for schools to deny students the right to form GSAs (Bennett, 2017).

Healthcare Practitioners

Trans people often face discrimination in health care settings, yet access to health care is vital for trans people, as those who seek medical transition require specialized care (Veale et al., 2015).

Often young trans people must receive a diagnosis of gender dysphoria to access health care services such as hormone therapy (in preparation for medical transitioning). Gender dysphoria is the extreme levels of distress some people experience due to the discrepancy between one’s assigned sex at birth and the gender with which one identifies.

Healthcare practitioners (including psychologists, nurses, general practitioners, psychiatrists and endocrinologists) need to strengthen adequate and timely access to gender-affirming healthcare for trans communities (Veale et al., 2015). They should be trained in gender diversity, and trans health should become a part of their required curriculum (Strauss et al., 2017).

Other Institutions

The wellbeing of trans people can be greatly affected by the characteristics, norms, practices, and spaces of institutional environments. There is a relationship between denial of access to bathrooms and gender-appropriate campus housing and increased risk for suicidality (Seelman, 2016).

“Suicidality among trans people is incredibly complex; relating to multiple individual, systemic and structural factors. It cannot be located solely within the individual, and any exploration of this must consider intersectional sources of oppression to fully capture its nuances” (McNeil et al., 2017, p.26).


Abramovich, I. (2012). No safe place to go: LGBTQ youth homelessness in Canada: Reviewing the literature. Canadian Journal of Family and Youth, 4(1), 29-51. Retrieved from

American Association of Suicidology. (2018). Know the Warning Signs of Suicide. Retrieved from

Bailey, L., Ellis, S., & McNeil, J. (2014). Suicide risk in the UK trans population and the role of gender transitioning in decreasing suicidal ideation and suicide attempt. Mental Health Review Journal, 19(4), 209-220.

Bauer, G., Zong, X., Scheim, A., Hammond, R. & Thind, A. (2015a). Factors impacting transgender

patients discomfort with their family physicians: A respondent-driven sampling study. PloSONE

2015; 10(12): e0145046.

Bauer, G., Schiem, A., Travers, R. & Hammond, R. (2015b). Intervenable factors associated with suicide risk in transgender persons: A respondent driven suicide risk sampling study in Ontario, Canada. BMC Public Health. DOI: 10.1186/s12889-015-1867-2 .

Bennett, D. (2017, November 15). Alberta passes contentious bill strengthening gay-straight alliance rules. Globe and Mail. Retrieved from

Egale Canada. (2011). Every Class in Every School: The first national climate survey on homophobia, biphobia, and transphobia in Canadian schools (Final Report – May 2011). Retrieved from

Haas, A., Eliason, M., Mays, V., Mathy, R., Cochran, S., D’Augelli, A., Silverman, M., Fisher, P., Hughes, T., Rosario, M., Russell, S., Malley, E., Reed, J., Litts, D.A., Haller, E., Sell, R.L., Remafed, G., Bradford, J., Beautrais, A.L., Brown, G.K., Diamond, G.M., Friedman, M.S., Farofalo, R., Turner, M.S., Hollibaugh, A. & Clayton, P. (2011). Suicide and suicide risk in lesbian, gay, bisexual and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1),10-51.DOI: 10.1080/00918369.2011.534038

Irwin, J., Coleman, J., Fisher, C. & Marasco, V. (2014). Correlates of suicide ideation among LGBT Nebraskans. Journal of Homosexuality, 61(8), 1172-1191.

McNeill, J., Ellis, S. & Eccles, S. (2017). Suicide in trans populations: A systematic review of prevalence and correlates. Psychology of Sexual Orientation. DOI:10.1037/sgd0000235. Retrieved from

Russell, S., Pollitt, A., Li, G. & Grossman, A. (2018). Chosen name is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health. DOI: 10.1016/j.jadohealth.2018.02.003

Saewyc, E., Konishi, C., Rose, H., & Homma, Y. (2014). School-based strategies to reduce suicidal ideation, suicide attempts and discrimination among sexual minority and heterosexual adolescents in western Canada. International Journal of Child and Youth Family Studies, 5(1), 89-112.

Seelman, K. (2016). Transgender adults’ access to college bathrooms and housing and the relationship to suicidality. Journal of Homosexuality, 63(10), 1378-1399.

Strauss, P., Cook, A., Winter, S., Watson, V., Wright Toussaint, D. & Lin, A. (2017). Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results. Telethon Kids Institute, Perth, Australia. Retrieved from–behaviour/trans-pathways-summary.pdf

Suicide Prevention Resource Center. (2008). Suicide risk and prevention in gay, lesbian, bisexual and transgender youth. Newton, MA: Education Development Center, Inc. Retrieved from

Veale, J., Saewyc, E., Frohard-Dourlent, H., Dobson, S., Clark, B. & the Canadian Trans Youth Health Survey Research Group. (2015). Being safe, being me: Results of the Canadian trans youth health survey. Vancouver, BC: Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia. Retrieved from

The suicide rate for transgender people is nearly 10 times the national rate. A center is changing that

Transgender center is one of the few in the country

The Transgender Health and Wellness Center in Cathedral City, California, helps LGBTQ individuals through a variety of resources — from hair removal to housing.

The suicide rate for transgender men and women is among the highest of any group in the country.

Now, there’s a new resource to help bring down those numbers.

It’s a rare kind of safe space in a town that’s been LGBTQ friendly for decades.

“I knew that physically I was in the wrong body,” Angelina Love said.

Love was born male. She started transitioning to female as a teenager and said she got into heavy drug use to deal with her mixed emotions.

“I was going through about an eight ball of cocaine a day,” Love said. “I was also abusing my pain medication.”

Now, five years sober, Love said she’s finally found a safe space in the Southern California desert.

“If it wasn’t for the Transgender Health and Wellness Center, I don’t think that I would physically be alive today,” she said.

The Transgender Health and Wellness Center in Cathedral City, California, is where people like Love can get all kinds of services, including laser hair removal.

“What I do here volunteering has the most impact of anywhere I’ve volunteered,” said registered nurse Laurie Merritt.

Merritt said these services are more than physical — they’re emotional.

“Something so simple with facial hair and getting rid of that facial hair has such a profound impact on someone’s life,” she said.

Life that could be lost without proper help.

Thomi Clinton, the executive director of the Transgender Health and Wellness Center, said more than 1.4 million people identify as transgender across the country, and many are suicidal.

“When you go into the rural areas it's even higher,” Clinton said.

According to the American Foundation for Suicide Prevention, more than 40 percent of transgender men and women in the U.S. have attempted to take their own life. That’s nearly 10 times the national average.

“By addressing those issues and those disparities, we’re actually able to improve people’s lives,” Clinton said.

And, ultimately, keep more people alive.

Clinton said this center is helping empower and employ members of Palm Springs’ transgender community. People like Hyde Johns, who came to the trans center after breaking up with his girlfriend.

“She didn’t want anything to do with me because she’s lesbian and I’m a trans man,” Johns said.

Now, this center is helping clothe and relocate Johns and his dog.

“If we start solving these issues then everyone can get off government assistance and start being productive members of society and taxpayers,” Clinton said.

At Palm Springs' annual pride parade, LGBTQ students from University of California, Riverside come out to support the trans community.

“They stone us for being gay or trans or ace or any of the above in the queer community,” said UCR student Pablo Gutierrez.

Gutierrez, who identifies as gay and asexual, says being an ally of the trans community gives him hope.

“If you go out in the streets holding hands with someone of the same gender, people give you looks, sometimes they scream out profanities to you,” he said. “Being here and being with like-minded people — it’s just so refreshing.”

Refreshing and reinvigorating as members of the trans community came out proudly flying their flag.

“There was a time when you really couldn’t be visible in the community because of a fear of violence,” Clinton said, adding that the more visible they become, the more accepted they will become.

And that’s being helped by a center that feels like home.

“Lives are very important no matter what they express gender wise, who they love or what they do,” Clinton said.

Psychosocial mediators of perceived stigma and suicidal ideation among transgender women



Transgender women (TGW) in the U.S. experience high rates of stigma, depression, and elevated rates of suicide. This study examined correlates of suicidal ideation and estimated the conditional indirect effects of perceived stigma and psychosocial mediators on suicidal ideation.


Suicidal ideation was reported by 33% (N =?30) of the study participants. In multivariable analysis, suicidal ideation was associated with sexual abuse (AOR?=?3.17, 95% CI?=?1.10–9.30), anxiety (AOR?=?1.74, 95% CI?=?1.10–2.73), family verbal abuse (AOR?=?2.99, 95% CI?=?1.10–8.40), stranger verbal abuse (AOR?=?3.21, 95% CI?=?1.02–10.08), and psychosocial impact of gender minority status (AOR?=?3.42, 95% CI?=?1.81–6.46). Partner support was found to be the protective factor for suicidal ideation (AOR?=?0.34, 95% CI?=?0.13–0.90). In the mediation analysis, the psychosocial impact of gender minority status mediated the relationship between perceived stigma and suicidal ideation. The estimated conditional indirect effect was 0.46, (95% CI?=?0.12–1.11).


Interventions that aim to reduce suicidal behaviors among TGW should address stigma, psychosocial impact of gender minority status, and different forms of violence and abuse.

Peer Review reports


Transgender is an umbrella term for individuals whose gender identity or gender expression differs from what is typically associated with the sex that they were assigned at birth. The transgender community includes individuals, who were assigned male at birth and identify as female, who were assigned female at birth and identify as male, and who identify their gender as outside the binary categories of male or female [1,2,3,4]. In the United States, there are significant disparities in suicide risk based on gender identity. Transgender populations have elevated rates of suicidal ideation and suicide [5,6,7]. According to the US Trans Survey (USTS), attempted suicide was reported by 40% of transgender women (TGW) survey participants compared to 1.6% in the general population and 10.2% among Lesbian, Gay, and Bisexual (LGB) participants [5, 8]. Similarly, other studies found that 32.4 to 45.8% of transgender study participants reported lifetime suicide attempts [9, 10]. Suicidal ideation which is defined as “thinking about, considering, or planning for suicide” is also highly prevalent among TGW [11]. Multiple studies have found prevalence rates of suicidal ideation among TGW that range from 35.1 to 79.2% [9, 12, 13]. In one study, an alarming 78.1% of the participants reported suicidal ideation in the past year [14]. Adams et al. in 2017 conducted a meta-analysis and reported that, across the 23 studies that were conducted from 1997 to 2016, among the transgender population, the prevalence of lifetime suicidal ideation was reported by 55%, and suicidal ideation in the past 12 months was reported by 51% [15]. The same study also found higher lifetime suicidality among TGW (51.7%) compared to transgender men (45.4%), gender non-conforming individuals (30%), and cross-dressers (25.6%). As would be expected, suicidal ideation among TGW has been strongly associated with a history of suicide attempts [11, 16,17,18], and is a strong predictor of future suicide attempts [19]. Together, these findings highlight the need to identify the correlates of suicidal ideation among TGW, which would help to inform interventions to prevent suicidal ideation and suicide attempts.

Among cisgender populations, that is, people whose gender identity and gender expression align with their assigned sex at birth [20], research has identified predictors of suicidal ideation, including substance abuse, experiences of violence, depression, anxiety, and other mental health issues [18, 21,22,23,24]. For TGW, in addition to these factors, psychosocial factors that are specific to TGW, including stigma and discrimination, microaggressions, experiences of abuse and violence, family rejection, and lack of social support, could contribute to disproportionate rates of suicidality [12, 13, 25,26,27]. According to the USTS, transgender participants experienced various forms of discrimination due to their gender identity [5, 28], including unemployment (30%), being refused a home or apartment (23%), verbal harassment (46%), being denied equal treatment by a government agency or official (24%), and mistreatment by police (58%) [5, 8]. Several other studies have reported that TG individuals experience high levels of transgender-related discrimination and stigma [29]. For example, transgender individuals have elevated rates of being denied access to care, as well as experience verbal harassment and physical violence, when attempting to access doctors and hospitals, emergency rooms, and using ambulances/by Emergency Medical Technicians [5, 8].

The stigma and discrimination experienced due to their gender identity may be associated with several adverse health outcomes among TGW [30]. Stigma may be indirectly associated with poor mental health in TGW by restricting their access to healthcare, housing, and employment [31, 32]. There also is evidence of a direct association between stigma and stress and subsequent mental health problems [30, 33, 34]. Societal attitudes toward TGW and the discrimination experienced by TGW on a daily basis may have a significant psychosocial impact on TGW and could be an important factor in explaining the mechanism that leads to mental health issues and negative health behaviors. For example, there is evidence that perceived stigma and discrimination are associated with anxiety and depressive symptoms [35, 36], distress [33], suicide attempts [25], and a host of other negative mental outcomes [35, 37].

Minority stress theory states that sexual and gender minorities experience stressors, such as discrimination and stigma, that lead to increased levels of stress that can, in turn, deplete psychological resources (e.g., resilience, social support) and lead to poor overall mental and physical health outcomes [38]. In this theory, perceived stress is viewed as the mediator of the association between sexual/gender minority status and negative health outcomes. A complement to the minority stress theory is the psychological mediation framework, which postulates that sexual and gender minorities experience stigma-related stress that leads to certain intra-and interpersonal psychological processes that can affect mental health [39]. Within this framework, perceived stress relates to gender minority status and is the main predictor of negative health outcomes but with psychological and psychosocial factors that explain the association. Several studies have applied these theories to explain the disproportionate rates of mental health issues among sexual and gender minorities [9, 14, 40,41,42].

There is evidence that psychological and psychosocial factors, such as substance use, depression, and anxiety, may explain the association between perceived stigma and suicidal ideation [13]. Substance use has been hypothesized as a potential negative coping mechanism for the stress associated with stigma and discrimination among transgender persons. Substance use has demonstrated strong associations with suicidal ideation and suicide attempts [43] and has found to be a statistically significant mediator between stigma and suicidality among transgender individuals [43]. Moreover, the depression and anxiety associated with experiencing stigma and discrimination may lead to suicidal ideation and suicide attempts [8, 13]. Taken together, these psychosocial factors, including anxiety, depression, negative impact of gender minority status, and substance use behaviors could be hypothesized as mediators. In this study, our goal is to examine the relationship between perceived stigma by TGW, the psychosocial factors that include anxiety and depression, and the psychosocial impact of gender minority status, substance use behaviors, and suicidal ideation.

Evidence for the prevalence and correlates of suicidal ideation among TGW is found in the literature [12, 13, 25,26,27], but there is limited research [9, 14, 27, 41] on the role of psychosocial factors and the underlying mechanisms associated with suicidal ideation. This critical research gap needs to be addressed, as the findings could inform researchers and policymakers in designing suicide prevention interventions for TGW in the United States. In this study, we aim to measure the prevalence of suicidal ideation and to identify the demographic and psychosocial correlates of suicidal ideation and the potential underlying pathways associated with suicidal ideation among TGW. The conceptual framework (Fig. 1) shows our hypothesized model of the psychosocial factors that explain the pathway between perceived stigma and suicidal ideation. The psychosocial factors include anxiety, depression, the psychosocial impact of gender minority status, and substance use behaviors.

Conceptual Diagram of the mediation models. Path c - Total effect of perceived stigma (X) on suicidal ideation (Y). path a - Effects of perceived stigma (X) on psychosocial factors (Mediators (M): anxiety, depression, the psychosocial impact of gender minority status, excessive drinking, injection drug use, and non-injection drug use). path b - Effects of psychosocial factors (M) on suicidal ideation (Y) controlling for perceived stigma (X). path c’ - Direct effect of perceived stigma (X) on suicidal ideation (Y) controlling for psychosocial factors (M)


Among the total study sample of TGW (N=?92), the prevalence of suicidal ideation was 33% (n=?30). The average age of participants was 35?years, 51% were homeless, 60% of the participants who are aware of their HIV status reported as HIV positive, 50% had more than a high-school education, and 84% identified as Black or African American (Table 1). Of the study participants, sexual abuse was reported by 62%, and child sex abuse was reported by 52%. Substance abuse behaviors included excessive drinking (21%), injection drug use (15%), and non-injection drug use (34%). Among the total study sample, the mean score for the perceived stigma measure was 4.03 (SD?=?0.66, range: 1–5), mean score of anxiety was 2.11 (SD?=?1.14, range: 1–5), mean score of depression was 2.01 (SD?=?0.85, range: 1–5), and mean score on the psychosocial impact of gender minority status measure was 2.63 (SD?=?0.94, range: 1–5). Family verbal abuse and stranger verbal abuse were reported by 53% and 63% of the study participants, respectively. As shown in Table 1, significant differences between TGW who experiencd sucidial ideation and those who had not were found on a host of demographic and psychosocial variables.

Table 1 Descriptive statistics by suicidal ideation among transwomen residing in Atlanta, Georgia

Full size table

In the multivariable analysis (Table 2), suicidal ideation was associated with sexual abuse (AOR: 3.17, 95% CI: 1.10, 9.30), higher anxiety scores (AOR: 1.74; 95% CI: 1.10, 2.73), psychosocial impact of gender minority status (AOR: 3.42, 95% CI: 1.81, 6.46), family verbal abuse (AOR: 2.99; 95% CI: 1.10, 8.40), stranger verbal abuse (AOR: 3.21; 95% CI: 1.02, 10.08), and partner support (AOR: 0.34; 95% CI: 0.13, 0.90). Depression, perceived stigma, non-injection drug use, intimate partner violence, child sex abuse, and HIV status were no longer associated with suicidal ideation in the multivariable analyses.

Table 2 Associations of suicidal ideation with risk factors among transwomen

Full size table

In the mediation analyses (Table 3), results showed that perceived stigma had a significant direct effect on the psychosocial impact of gender minority status (path a), (0.38, SE?=?0.15, 95% CI?=? The psychosocial impact of gender minority status also was significantly associated with suicidal ideation (path b) (1.19, SE?=?0.33, 95% CI?=?0.53,1.85), and there was a significant indirect effect (path ab) of the psychosocial impact of gender minority status on the association between perceived stigma and suicidal ideation (0.46, SE?=?0.26, 95% CI: 0.12, 1.11). The other psychosocial mediator variables, anxiety, depression, excessive drinking, injection drug use, and non-injection drug use, were not significant mediators. The mediation effect size was estimated by calculating the ratio of (path ab/path c) [52]. The psychosocial impact of gender minority status mediated 77% of the effect of perceived stigma on suicidal ideation.

Table 3 Summary of mediation effects of psychosocial factors between perceived stigma and suicidal ideation

Full size table


In this study, we sought to determine the correlates for suicidal ideation among TGW and examined the mediation pathways that explain the underlying relationships. In our sample, the prevalence of suicidal ideation was 33%, within the range reported by other studies [13, 53]. We found that psychosocial factors, including anxiety, perceived stigma of being transgender, the psychosocial impact of gender minority status, experiencing sexual abuse, family verbal abuse, and stranger verbal abuse were significantly associated with higher odds of suicidal ideation. Partner support was found to be a protective factor.

Using the postulates of minority stress theory and the psychological mediation framework, we investigated whether certain psychosocial factors explained the associations between perceived stigma and suicidal ideation. We found that the psychosocial impact of gender minority status was a statistically significant mediator in our sample, indicating that the effect of perceived stigma on suicidal ideation may be explained by this pathway. The other psychosocial mediators examined, depression, anxiety, and substance use behaviors, were not statistically significant, which is contrary to the findings of previous research [43].

The risk factors that we found to be significantly associated with suicidal ideation are in keeping with those of other studies that reported a lack of or low social support [7, 13, 54], sexual abuse and gender-based discrimination [25], family verbal abuse [12], stigma and discrimination [26], and the psychosocial impact of gender minority status and internalized transphobia [10]. Taken together, these societal-level risk factors suggest that TGW are at risk for a multitude of traumatic experiences that have severe mental health sequelae. Until there is a shift in societal attitudes and norms, TGW could benefit from public health interventions, such as mind-body programs [55] that enhance resiliency and improve coping, or online-eHealth interventions [56] that provide a safe space to improve skills and receive support. At a minimum, mental health professionals and social service providers who work with this population should be sensitive to the abuse history and mental health needs of the TGW with whom they work.

As would be expected, interpersonal factors, such as experiencing sexual abuse; psychosocial factors, such as anxiety and depression; and trans-specific factors, such as perceived stigma, family and stranger verbal abuse due to gender identity; and the psychosocial impact of gender minority status predicted the likelihood of suicidal ideation among TGW. We also found that partner support was a protective factor among TGW, similar to other studies that found a reduced risk of suicidal ideation among the TGW with higher levels of social support [13], indicating the vital role of a support system for TGW. These findings suggest that interpersonal, trans-specific, and psychosocial factors should be the focus in the development of suicide prevention interventions.

We found that the construct, the psychosocial impact of gender minority status, which measures the psychosocial distress experienced by TGW related to their unique gender identity, was significantly associated with suicidal ideation. The psychosocial impact of gender minority status is different from the other general forms of distress, such as anxiety, psychological distress, and depression [46], and represents the psychological impact of stigma and discrimination based on gender identity. This result indicates that this specific form of distress related to TGW is a significant predictor of suicidal ideation. Structural interventions to change the policies and laws to combat the stigma and discrimination against TGW are necessary.

We also found that the psychosocial impact of gender minority status was a statistically significant mediator that partially explains the relationship between perceived stigma and suicidal ideation. This finding was similar to the studies that: (a) reported that internalized trans-negativity (sometimes referred to as internalized transphobia) mediated the relationship between distal stressors (such as anti-trans stigma, discrimination and victimization) and suicidal ideation [40], and (b) applied the minority stress theory to TGW and found that, internal stressors (internalized transphobia) mediated the relationship between external distal stressors (anti-trans discrimination, stigma, and victimization) and suicidal ideation [9]. The model used in our study, however, was conceptualized differently from the frameworks applied in these previous studies. In our model, perceived stigma tapped into TGW’s perceptions of the prejudice and discrimination in their community. In this context, perceived stigma could be viewed as a proxy for distal external and objective stressors. We found that perceived stigma nonetheless had an impact on psychological processes among the TGW in our study. The implication of this conceptualization is that perceptions of the societal anti-transgender attitudes and structural level anti-transgender polices are important to assess even if they are considered as proxies for distal objective measures of stressors and that, for some TGW, perceptions are important to their mental health. TGW who perceive transgender-related stigma in our study, experienced increased psychosocial effects that could eventually be manifested in behaviors such as suicidal ideation.


TGW are disproportionately affected by suicidal ideation and are in urgent need of tailored and effective interventions to ameliorate their mental health concerns. Interventions that increase social inclusion may be particularly beneficial [13]. In one intervention utilizing mHealth to promote social support among TGW, a significant decrease in depressive symptoms and an increase in social inclusion was observed [56]. Moreover, policy-level interventions that aim at decreasing stigma, discrimination, and transphobia are likely to positively impact transgender individuals [13]. Education on gender diversity may also mitigate transphobia and raise awareness on gender identity [40]. Specifically, clinicians and psychologists should be culturally competent in the psychological issues and gender identity specific to TGW [41]. Clinicians should also use Minority Stress Theory as a framework for assessing and treating their gender minority patients. They also need to consider how experiences and perceptions of stigma and discrimination are chronic stressors that TGW must cope with and ultimately may manifest in internalized processes that contribute to risk behaviors and negative mental health outcomes [41, 57]. Further, clinicians should support resiliency factors that are incorporated in minority stress theory, including group social support and encourage connecting to sexual and gender minority communities. Individual-level change also is critical to address the internalized stigma and trans-negativity among TGW. Based on the high levels of internalized stigma and the strong association with negative mental health outcomes, mental health professionals should work with TGW to address trans-negativity and provide healthy coping skills [40]. It is clear that structural-level interventions that seek to reduce stigma and discrimination and may have an effect on TGW’s perceptions and experiences are greatly needed. By changing societal attitudes, including those of healthcare providers and structures (e.g., clinics, systems, etc.), ultimately, negative psychosocial impacts will be lessened, and TGW will expereience improved access, engagement, quality of care, and mental health outcomes (including decreased risk of suicide). Future research should focus on creating and evaluating multilevel interventions to help reduce suicidal ideation among TGW as well as evaluating the effectiveness of treatment that is based on the minority stress framework to clinical practice.


AOR: Adjusted Odds Ratio

CBO: Community Based Organization

CI: Confidence Intervals

LGBT: Lesbian Gay Bisexual, and Transgender

MSM: Men who have sex with men

OR: Odds Ratio

TGW: Transgender women


1. Bockting WO. Psychotherapy and the real-life experience: from gender dichotomy to gender diversity. Sexologies. 2008;17(4):211–24.

2. Bockting WO, et al. Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community. AIDS Care. 2005;17(3):289–303.

3. Wo B. From construction to context: gender through the eyes of the transgendered. SIECUS Rep. 1999;28(1):3.

4. Association, A.P. Report of the APA task force on gender identity and gender variance. Washington, DC: American Psychological Association; 2009.

5. Grant JM, et al. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.

6. Marshall E, et al. Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. Int Rev Psychiatry. 2016;28(1):58–69.

7. Mustanski B, Liu RT. A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth. Arch Sex Behav. 2013;42(3):437–48.

8. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. transgender survey. Washington, DC: National Center for transgender equality; 2016.

9. Testa RJ, et al. Suicidal ideation in transgender people: gender minority stress and interpersonal theory factors. J Abnorm Psychol. 2017;126(1):125–36.

10. Perez-Brumer A, et al. Individual- and structural-level risk factors for suicide attempts among transgender adults. Behav Med. 2015;41(3):164–71.

11. Crosby AE, O. L, Melanson C. Self-directed violence surveillance: uniform definitions and recommended data elements. Atlanta: Centers for Disease Control and Prevention, National Center for injury prevention and Control; 2011.

12. Grossman AH, D'Augelli AR. Transgender youth and life-threatening behaviors. Suicide Life Threat Behav. 2007;37(5):527–37.

13. Bauer GR, et al. Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health. 2015;15:525.

14. Tebbe EA, Moradi B. Suicide risk in trans populations: an application of minority stress theory. J Couns Psychol. 2016;63(5):520–33.

15. Adams N, Hitomi M, Moody C. Varied reports of adult transgender suicidality: synthesizing and describing the peer-reviewed and gray literature. Transgend Health. 2017;2(1):60–75.

16. Brown GK. A review of suicide assessment measures for intervention research in adults and older adults. Bethesda: National Institute of Mental Health; 2002.

17. Ahrens B, et al. Suicidal behavior--symptom or disorder? Compr Psychiatry. 2000;41(2 Suppl 1):116–21.

18. Oquendo MA, et al. Sex differences in clinical predictors of suicidal acts after major depression: a prospective study. Am J Psychiatry. 2007;164(1):134–41.

19. De Leo D, et al. Repetition of suicidal behaviour in elderly Europeans: a prospective longitudinal study. J Affect Disord. 2002;72(3):291–5.

20. Center NLHE. Glossary of LGBT terms for health care teams. Boston: The Fenway Institute; 2017.

21. May AM, Klonsky ED, Klein DN. Predicting future suicide attempts among depressed suicide ideators: a 10-year longitudinal study. J Psychiatr Res. 2012;46(7):946–52.

22. Han B, McKeon R, Gfroerer J. Suicidal ideation among community-dwelling adults in the United States. Am J Public Health. 2014;104(3):488–97.

23. Nock MK, et al. Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(8):868–76.

24. Vanderwerker LC, et al. Differences in risk factors for suicidality between African American and White patients vulnerable to suicide. Suicide Life Threat Behav. 2007;37(1):1–9.

25. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex. 2006;51(3):53–69.

26. Haas A, Rodgers P, Herman J. Suicide Attempts Among Transgender and Gender Non-Conforming Adults: finding of the National Transgender Discrimination Survey; 2014.

27. Klein A, Golub SA. Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults. LGBT Health. 2016;3(3):193–9.

28. Valentine SE, Shipherd JC. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev. 2018;66:24–38.

29. Operario D, et al. Stigma and the syndemic of HIV-related health risk behaviors in a diverse sample of transgender women. J Community Psychol. 2014;42(5):544–57.

30. White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222–31.

31. Nemoto T, Bödeker B, Iwamoto M. Social support, exposure to violence and transphobia, and correlates of depression among male-to-female transgender women with a history of sex work. Am J Public Health. 2011;101(10):1980–8.

32. Reisner SL, et al. Legal protections in public accommodations settings: a critical public health issue for transgender and gender-nonconforming people. Milbank Q. 2015;93(3):484–515.

33. Bockting WO, et al. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;103(5):943–51.

34. Gamarel KE, et al. Gender minority stress, mental health, and relationship quality: a dyadic investigation of transgender women and their cisgender male partners. J Fam Psychol. 2014;28(4):437–47.

35. Gamarel KE, et al. Association between socioeconomic position discrimination and psychological distress: findings from a community-based sample of gay and bisexual men in new York City. Am J Public Health. 2012;102(11):2094–101.

36. Yang MF, et al. Stigmatization and mental health in a diverse sample of transgender women. LGBT Health. 2015;2(4):306–12.

37. Veale JF, et al. Enacted stigma, mental health, and protective factors among transgender youth in Canada. Transgend Health. 2017;2(1):207–16.

38. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

39. Hatzenbuehler ML. How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychol Bull. 2009;135(5):707–30.

40. Staples JM, et al. The role of distal minority stress and internalized Transnegativity in suicidal ideation and nonsuicidal self-injury among transgender adults. J Sex Res. 2018;55(4–5):591–603.

41. Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pract. 2012;43(5):460–7.

42. Scandurra C, et al. Internalized transphobia, resilience, and mental health: Applying the psychological mediation framework to Italian transgender individuals. Int J Environ Res Public Health. 2018;15(3):508.

43. Mereish EH, O'Cleirigh C, Bradford JB. Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities. Psychol Health Med. 2014;19(1):1–13.

44. Ross MW, Rosser BR. Measurement and correlates of internalized homophobia: a factor analytic study. J Clin Psychol. 1996;52(1):15–21.

45. Smolenski DJ, et al. Revision, criterion validity, and multigroup assessment of the reactions to homosexuality scale. J Pers Assess. 2010;92(6):568–76.

46. Sjoberg MD, Walch SE, Stanny CJ. Development and initial psychometric evaluation of the transgender adaptation and integration measure (TG AIM). Int J Transgend. 2006;9(2):35–45.

47. Derogatis LR. Brief symptom inventory (BSI) 18: administration, scoring, and procedures manual. Minneapolis: NCS Pearson; 2000.

48. DHHS. Dietary Guidelines for Americans, 2015–2020. T.U.S.D.o.H.a.H. services, Editor; 2015.

49. Mackinnon DP, Dwyer JH. Estimating mediated effects in prevention studies. Eval Rev. 1993;17(2):144–58.

50. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.

51. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Methodology in the social sciences, Guilford Press; 2013.

52. Preacher KJ, Kelley K. Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods. 2011;16(2):93–115.

53. Perez-Brumer A, et al. Prevalence and correlates of suicidal ideation among transgender youth in California: findings from a representative, population-based sample of high school students. J Am Acad Child Adolesc Psychiatry. 2017;56(9):739–46.

54. Factor RJ, Rothblum ED. A study of transgender adults and their non-transgender siblings on demographic characteristics, social support, and experiences of violence. J LGBT Health Res. 2007;3(3):11–30.

55. Gotink RA, et al. Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS One. 2015;10(4):e0124344.

56. Hightow-Weidman LB, et al. HealthMpowerment.Org: building community through a Mobile-optimized, online health promotion intervention. Health Educ Behav. 2015;42(4):493–9.

57. Alessi EJ. A framework for incorporating minority stress theory into treatment with sexual minority clients. J Gay Lesbian Mental Health. 2014;18(1):47–66.

Attempted Suicide Rate for Multiracial Transgender People Thirty-Three Times Higher than General Population

Racism and transphobia are deeply impacting the lives of multiracial (people of more than one race) transgender people in the US according to a new factsheet co-created by the National Gay and Lesbian Task Force, The National Center for Transgender Equality (NCTE) and The Trans People of Color Coalition (TPOCC).

The fact sheet, the final installment of the Trans Justice/Racial Justice series based on the landmark report, Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, indicates that multiracial transgender people are experiencing disproportionately higher levels of attempted suicide, poverty and unemployment.

“This is a wake-up call: racism and anti-trans discrimination together are having an appalling impact on multiracial transgender people’s lives, and it has to stop,” said Darlene Nipper, Task Force Deputy Executive Director. “Transgender people deserve a fair shot at the American Dream including access to good jobs that are free from discrimination. That’s why we need politicians to listen to the American public and pass important pieces of legislation such as the Employment Non-Discrimination Act now.”

Specifically, the new factsheet shows that over half (54%) of multiracial respondents reported having attempted suicide, compared to 41% of all study respondents and 1.6% of the general U.S. population. Multiracial transgender and gender non-conforming people often live in extreme poverty, with 23% reporting a household income of less than $10,000/year. This is higher than the rate for transgender people of all races (15%), the general U.S. multiracial population rate (15%), and almost six times the general U.S. population rate (4%).

The one piece of good news in the report is that 37% of multiracial respondents reported experiencing significant family acceptance, and over half (61%) reported that their relationships with family slowly improved over time after coming out as transgender. Those respondents who were accepted by their families were much less likely to face discrimination and reported lower rates of homelessness, attempted suicide and HIV/AIDS.

The new factsheet completes a series of five spotlighting the experiences of Black respondents with the National Black Justice Coalition (NBJC); Latino and Latina respondents with the League of Latin American Citizens (LULAC); Asian American, South Asian, Southeast Asian, and Pacific Islander respondents with the National Queer Asian Pacific Islander Alliance (NQAPIA); and American Indian and Alaskan Native respondents.

Studies: Suicide attempts high among transgender teens, increasing among black teens - 10/14/19

Two new studies on suicide found an increase in suicide attempts by black teens and higher rates of attempts among transgender teens than their peers.

Teen suicide has been on the rise and is the second leading cause of death for this age group. Researchers from both studies set out to look more closely at risk factors to inform prevention efforts.

Race and gender trends

Researchers explored trends in suicidal ideation and attempts by race and gender from 1991-2023 using data on nearly 200,000 high school students from the nationally representative Youth Risk Behavior Survey.

The data showed 19% of teens had seriously considered suicide, 15% had made a plan to commit suicide, 8% had attempted suicide and 2.5% had been injured by a suicide attempt.

“Despite increased attention given to the creation of campaigns to reduce youth suicide in the US over the last decade, these findings suggest that continued concern and attention regarding suicidal behaviors among high school-aged youth is warranted,” authors wrote in “Trends of Suicidal Behaviors among High School Students in the United States: 1991-2023,” (Lindsey MA, et al. Pediatrics. Oct. 14, 2019,

Rates of suicidal ideation and suicide planning decreased for all races. However, suicide attempts increased among black males and females and injury from suicide attempts increased among black males.

Authors said black teens may not be getting the mental health treatment they need and may be dealing with racial discrimination or adverse childhood experiences.

In a video abstract, lead author Michael A. Lindsey called the findings “surprising and alarming” and said research is needed on suicide risk factors and prevention.

“It is critical to develop and test suicide intervention and prevention programs tailored for the black community, reducing the stigma related to mental illness and increasing help-seeking behaviors in clinical and non-clinical settings,” said Dr. Lindsey, executive director of the New York University McSilver Institute for Poverty Policy and Research.

Transgender suicide rates

In another study, University of Pittsburgh researchers analyzed data from an online survey of 2,020 14- to 18-year-olds to explore rates of suicidal ideation and attempts by transgender teens.

They found transgender adolescents (TGAs) had higher rates of suicidal ideation, plans, attempts and attempts requiring medical care compared to cisgender teens. They also had higher rates of non-suicidal self-injury, according to “Suicidality Disparities between Transgender and Cisgender Adolescents,” (Thoma BC, et al. Pediatrics. Oct. 14, 2019,

Their study also delved into subgroups of adolescent gender identity. Among the findings were that cisgender females, transgender males and nonbinary adolescents assigned female at birth had higher rates in all suicide-related categories compared to cisgender males.

“TGAs should be prioritized in future research examining adolescent suicidality, including explicating mechanisms of suicidality among TGAs to inform future intervention and prevention strategies designed to reduce suicidality within this vulnerable population,” authors wrote.


  • Related commentary “Increases in Rates of Suicide and Suicide Attempts Among Black Adolescents”
  • AAP-endorsed "Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment and Initial Management"
  • AAP-endorsed "Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management"
  • Information for parents from on preventing suicide
  • AAP clinical report "Suicide and Suicide Attempts in Adolescents"


Between the (Gender) Lines: the Science of Transgender Identity

Think of your most noticeable feature. Maybe it’s your radiant smile, or your long, piano-playing fingers. Maybe it’s your stellar jump shot, or the way you recite Shakespearean sonnets at the drop of a hat. Or maybe it’s your penchant for scientific knowledge. But whatever it is, for better or worse, it is probably not your most salient feature to the world around you. To others, our most salient feature is one that doesn’t make any of us very salient at all – a feature in which none of us had any say in, which was assigned at, or prior to, birth: are you male or female?

Gender identity haunts every aspect of our lives, dictating the outcomes of our conversations, our workplaces, our relationships – even our bath products. Before most infants are named, they are assigned a sex based on the appearance of their external genitalia by a third party. These decisions are dolled out in a typically binary fashion, with no expectations for ambiguity. This is the norm – but has this simplicity led us astray?

In March of 2016, Governor Pat McCrory of North Carolina signed into law the Public Facilities Privacy and Security Act, banning individuals from public restrooms that do not correspond to their assigned biological sex. This controversial legislation was the first of its kind– though certainly not for lack of trying. So called “bathroom bills” have been within political radar since the introduction of public restrooms in the 19th century; dozens of states within the U.S, primarily in the Midwest and South, have attempted, but failed, to bring such bills into law in the past year. The charged political climate of the summer has yielded many tense conversations about gender and LGBT rights – and it’s clear that these discussions are long overdue. But if we are to regulate gender, we must first assess the extent of our knowledge on the topic. What do we know of the “causes” the phenomenon of transgender identity – and what does this mean for the future of transgender politics?

The ABC’s (and LGBTQQIAAP+2S’s) of Gender and Sexuality

First, some (controversial) definitions. It would be remiss to claim to be able to define or categorize all variations in human sexuality and gender (hence the continually lengthening acronyms used, sometimes tongue in cheek, by the community); one of the larger acronyms, LGBTQQIAAP, still humbly accepts that it is not all-inclusive. These lists, while not exhaustive, are exhausting. The labels are useful in some respects, much like any other label denoting origin or role – they help us navigate social situations and can often be signs of respect. It is a natural human inclination to categorize, but broad assumptions can also lead to stereotyping. To limit the scope of this article, we will focus on transgender identity.

Those persons who identify as transgender (the “T” in many queer community acronyms) are those who identify with a gender that differs from their assigned sex. This juxtaposes cisgender, or those who identify with their assigned gender. Though the typical assigned sexes are “male” and “female,” often designated at birth, being transgender does not limit gender identity to these two categories, as many who identify as transgender do not feel they are exclusively masculine or feminine. Importantly, transgender identity is independent of sexual orientation. The subset of transgender individuals who choose to undergo sexual reassignment surgery are often denoted as transsexual.

The transgender identity has long been associated with poor mental health, particularly the diagnoses of “gender identity disorder” and “gender dysphoria.” However, the World Health Organization is actively working towards declassifying transgender identity as a mental disorder, a change partially prompted by a recent study uncoupling the mental and physical health problems experienced by transgender people from their gender identity. Rather, those who had suffered ailments could vastly attribute their afflictions to societal stigma, discrimination, and violence.

“It’s All in Your Head” – Except When It’s Not

Sex determination – the way we are “coded” into a biological sex – is complicated in and of itself. There are far more options than just “male” or “female,” and countless instances of species that can actually transition from one sex to another within a single lifetime. With most mammals, however, the majority of individuals are cisgender male or female; transgender individuals are estimated to comprise about 0.3% of the adult U.S. population.

Little is known about the causes of transsexuality, and many of the studies that have been conducted – particularly psychological studies – have since been widely discredited (more on that later). However, scientists do seem to have some information on the biological basis of several factors.

First and foremost, is gender identity genetic? It seems the answer is yes – though, as with most traits involving identity, there is some environmental influence. One classic way for scientists to test whether a trait (which can be any characteristic from red hair to cancer susceptibility to love of horror movies) is influenced by genetics is twin studies. Identical twins have the exact same genetic background, and are usually raised in the same environment. Fraternal (nonidentical) twins, however, share only half their genes, but tend to also be raised in the same environment. Thus, if identical twins tend to share a trait more than fraternal twins, that trait is probably influenced by genetics. Several studies have shown that identical twins are more often both transgender than fraternal twins, indicating that there is indeed a genetic influence for this identity. So, what genes might be responsible?

In 1995 and 2000, two independent teams of researchers decided to examine a region of the brain called the bed nucleus of the stria terminalis (BSTc) in trans- and cisgender men and women. The BSTc functions in anxiety, but is, on average, twice as large and twice as densely populated with cells in men compared to women. This sexual dimorphism is pretty robust, and though scientists don’t know why it exists, it appears to be a good marker of a “male” vs. “female” brain. Thus, these two studies sought to examine the brains of transgender individuals to figure out if their brains better resembled their assigned or chosen sex.

Interestingly, both teams discovered that male-to-female transgender women had a BSTc more closely resembling that of cisgender women than men in both size and cell density, and that female-to-male transgender men had BSTcs resembling cisgender men. These differences remained even after the scientists took into account the fact that many transgender men and women in their study were taking estrogen and testosterone during their transition by including cisgender men and women who were also on hormones not corresponding to their assigned biological sex (for a variety of medical reasons). These findings have since been confirmed and corroborated in other studies and other regions of the brain, including a region of the brain called the sexually dimorphic nucleus (Figure 2) that is believed to affect sexual behavior in animals.

It has been conclusively shown that hormone treatment can vastly affect the structure and composition of the brain; thus, several teams sought to characterize the brains of transgender men and women who had not yet undergone hormone treatment. Several studies confirmed previous findings, showing once more that transgender people appear to be born with brains more similar to gender with which they identify, rather than the one to which they were assigned.

Interestingly, while the hormone treatments may have caused issues in the previous studies, they also gave scientists clues as to how these differences in brain anatomy may have arisen. Brain development is heavily influenced by the prenatal environment – what hormones the fetus is exposed to in its mother’s uterus. Some scientists believe that female-to-male transgender men, for instance, may have been exposed to inadequate levels of estrogen during development. This phenomenon could have two causes: 1) not enough estrogen in the fetus’s immediate environment, or 2) enough estrogen in the environment, but poor sensitivity in the fetus. Think of it like a cell phone tower controlling remote calls – the tower may not be producing enough signal (scenario 1), or the receiving phone may be unable to process the message (scenario 2). In either case, the call doesn’t make it through.

Possible scenarios underlying insufficient feminization. During normal feminization, sufficient estrogen is present in the fetal environment. The estrogen is recognized by fetal cells and triggers the development of a female fetus. In Scenario 1, very little estrogen is present in the fetal environment. Even though the fetal cells are capable of sensing estrogen, very little enters the fetal environment and the fetus is insufficiently feminized. In Scenario 2, there is enough estrogen in the fetal environment, but fetal cells are effectively “deaf” to the estrogen and the fetus is insufficiently feminized.Figure 3: Possible scenarios underlying insufficient feminization. During normal feminization, sufficient estrogen is present in the fetal environment. The estrogen is recognized by fetal cells and triggers the development of a female fetus. In Scenario 1, very little estrogen is present in the fetal environment. Even though the fetal cells are capable of sensing estrogen, very little enters the fetal environment and the fetus is insufficiently feminized. In Scenario 2, there is enough estrogen in the fetal environment, but fetal cells are effectively “deaf” to the estrogen and the fetus is insufficiently feminized.

The amount of estrogen in the fetal environment is a little tough to measure – but there appears to be some evidence for transgender individuals having poor hormonal sensitivity in the womb. A team of researchers found that the receptor for estrogen (that is, the cell phone receiving the signal) seems to be a little worse at receiving signal in female-to-male transgender men – think a 2001 flip phone trying to process photos from Instagram. Thus, the signal doesn’t come through as clearly, and the externally “female” fetus ends up more masculinized.

The psychological studies that have attempted to unravel the causes of transsexuality, on the other hand, have largely failed to gain traction in modern times. For many years, psychologists characterized transgender identity as a psychological disorder. Some, for instance, believed it was a coping mechanism to “rectify” latent feelings of homosexuality, or the result of environmental trauma or “poor” parenting. No studies have been able to demonstrate this, however, and these “findings” are considered outdated and have been highly criticized for their discriminatory implications. Other psychologists have attempted to differentiate groups of transsexuals based on factors such as IQ and ethnicity; similarly, these theories have been overwhelmingly rejected due to poor study design and issues with ethics.

And so, while the list of causes for transgender identity continues to grow, it has become quite clear that it is not a conscious choice – similar to what has been described for the “reasons” behind sexual orientation. Still, at least 63% of transgender individuals experience debilitating acts of discrimination on a regular basis, including incarceration, homelessness, and physical assault. When about 1.7% of the population is in some way affected by cases of ambiguous genitalia at birth, these findings seem staggering.

So, where do we stand on transgender issues? Science tells us that gender is certainly not binary; it may not even be a linear spectrum. Like many other facets of identity, it can operate on a broad range of levels and operate outside of many definitions. And it also appears that gender may not be as static as we assume. At the forefront of this, transgender identity is complex – it’s unlikely we’ll ever be able to attribute it to one neat, contained set of causes, and there is still much to be learned. But we know now that several of those causes are biological. These individuals are not suffering a mental illness, or capriciously “choosing” a different identity. The transgender identity is multi-dimensional – but it deserves no less recognition or respect than any other facet of humankind.

Regional gray matter variation in male-to-female transsexualism


Gender identity-one's sense of being a man or a woman-is a fundamental perception experienced by all individuals that extends beyond biological sex. Yet, what contributes to our sense of gender remains uncertain. Since individuals who identify as transsexual report strong feelings of being the opposite sex and a belief that their sexual characteristics do not reflect their true gender, they constitute an invaluable model to understand the biological underpinnings of gender identity. We analyzed MRI data of 24 male-to-female (MTF) transsexuals not yet treated with cross-sex hormones in order to determine whether gray matter volumes in MTF transsexuals more closely resemble people who share their biological sex (30 control men), or people who share their gender identity (30 control women). Results revealed that regional gray matter variation in MTF transsexuals is more similar to the pattern found in men than in women. However, MTF transsexuals show a significantly larger volume of regional gray matter in the right putamen compared to men. These findings provide new evidence that transsexualism is associated with distinct cerebral pattern, which supports the assumption that brain anatomy plays a role in gender identity.

Transgender: By the numbers

How many people in the U.S. are lesbian, gay, bisexual and transgender?

Precise numbers do not exist. But a growing number of population-based surveys include questions designed to offer better measurements of sexual identification and gender identity.

The most recent data from surveys including the 2006-2008 National Survey of Family Growth, the 2009 California Health Interview Survey and federal data such as the Decennial Census or the American Community Survey were analyzed by Gary Gates, a distinguished scholar at the Williams Institute of the UCLA School of Law.

Gates, co-author of "The Gay and Lesbian Atlas," released a detailed report on LGBT numbers in an April 2011 study from the Williams Institute. Among his findings:

  • There are nearly 700,000 transgender individuals in the U.S., or 0.3% of the adult population.
  • Of those who identify as transgender, a majority have taken some steps to transition from one gender to another.
  • There are more than 8 million adults who identify as LGB in the U.S., or 3.5% of the adult population.
  • An unknown number of transgender individuals also identity as LGB, so there is some overlap.
  • Among adults who identify as LGB, bisexuals comprise a slight majority, 1.8% compared to 1.7% lesbian or gay.
  • Women are substantially more likely than men to identify as bisexual, 2.2% compared to 1.1% lesbian.
  • An estimated 19 million Americans, or 8.2% of adults, report they have engaged in same-sex sexual behavior.
  • Nearly 25.6 million Americans, or 11% of adults, report they have had at least some same-sex attraction.

Source: The Williams Institute, UCLA School of Law

Discrimination against transgender people in New York state:

Workplace discrimination:

  • 74% harassed or mistreated on the job
  • 20% lost a job
  • 20% were denied a promotion
  • 37% were not hired after interview

School harassment:

  • 75% in grades K-12 reported harassment
  • 35% physical assault
  • 12% sexual violence
  • 14% left school after prolonged harassment

Economic insecurity:

  • 19% had a household income of $10,000 or less, compared to 4% for general population
  • 12% are unemployed, compared to 7% nationally at the time of the survey

Housing discrimination:

  • 8% were evicted
  • 19% were denied a home or apartment
  • 18% became homeless due to gender expression
  • 24% had to find a temporary place to stay
  • 25% had to move back in with family or friends
  • 23% owned a home, compared to 67% for general population

Services and harassment:

  • 53% verbally harassed in hotels, restaurants, airports or government agencies
  • 18% denied equal treatment by government official or agency
  • 11% denied equal treatment by judges or court officials
  • 22% harassed by police officers
  • 49% uncomfortable asking for police assistance

Health care discrimination and mental health:

  • 17% refused medical care due to gender expression
  • 5.4% HIV positive, compared to 0.6% for general population
  • 29% postponed needed medical care due to discrimination
  • 36% attempted suicide, 22 times the 1.6% rate for the general population

Source: National Transgender Discrimination Survey. (Based on 531 respondents in New York in a survey by the National Center for Transgender Equality and the National Gay and Lesbian Task Force)

Male-to-female transsexuals have female neuron numbers in a limbic nucleus


Transsexuals experience themselves as being of the opposite sex, despite having the biological characteristics of one sex. A crucial question resulting from a previous brain study in male-to-female transsexuals was whether the reported difference according to gender identity in the central part of the bed nucleus of the stria terminalis (BSTc) was based on a neuronal difference in the BSTc itself or just a reflection of a difference in vasoactive intestinal polypeptide innervation from the amygdala, which was used as a marker. Therefore, we determined in 42 subjects the number of somatostatin-expressing neurons in the BSTc in relation to sex, sexual orientation, gender identity, and past or present hormonal status. Regardless of sexual orientation, men had almost twice as many somatostatin neurons as women (P < 0.006). The number of neurons in the BSTc of male-to-female transsexuals was similar to that of the females (P = 0.83). In contrast, the neuron number of a female-to-male transsexual was found to be in the male range. Hormone treatment or sex hormone level variations in adulthood did not seem to have influenced BSTc neuron numbers. The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder.

Similar articles

A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. Garcia-Falgueras A, Swaab DF. Brain. 2008 Dec;131(Pt 12):3132-46. doi: 10.1093/brain/awn276. Epub 2008 Nov 2. PMID: 18980961

A sex difference in the human brain and its relation to transsexuality. Zhou JN, Hofman MA, Gooren LJ, Swaab DF. Nature. 1995 Nov 2;378(6552):68-70. doi: 10.1038/378068a0. PMID: 7477289

Sexual differentiation of the bed nucleus of the stria terminalis in humans may extend into adulthood. Chung WC, De Vries GJ, Swaab DF. J Neurosci. 2002 Feb 1;22(3):1027-33. doi: 10.1523/JNEUROSCI.22-03-01027.2002. PMID: 11826131 Free PMC article.

The transsexual brain--A review of findings on the neural basis of transsexualism. Smith ES, Junger J, Derntl B, Habel U. Neurosci Biobehav Rev. 2015 Dec;59:251-66. doi: 10.1016/j.neubiorev.2015.09.008. Epub 2015 Sep 30. PMID: 26429593 Review.

Brain research, gender and sexual orientation. Swaab DF, Gooren LJ, Hofman MA. J Homosex. 1995;28(3-4):283-301. doi: 10.1300/J082v28n03_07. PMID: 7560933 Review.

Understanding the Stigma Faced by Transgender Women

Transgender people face an incredible burden of discrimination in almost every aspect of their lives. Despite increased representation in media and the fact that three in 10 U.S. adults personally know a person who is trans,1????? discrimination again trans individuals is still prevalent.

Based on a comprehensive survey of transgender discrimination published in 2016:

  • More than half of youth perceived as transgender have been harassed at school.
  • A quarter of transgender youth had been physically attacked.
  • 10% had been sexually assaulted in the previous year.
  • More than 50% had been sexually assaulted in their lifetimes2??2?

If you are seeking support contact the Trans Lifeline - 877-565-8860. Also contact The Trevor Project1-866-488-7386 or Text "START" to 678678 for issues with coming out, relationships, bullying, self-harm, and more or the LGBT National Hotline at 1-888-843-4564 for one-to-one peer support Monday thru Friday from 1pm to 9pm, pacific time.Saturday from 9am to 2pm, pacific time.

For more mental health resources, see our National Helpline Database.

Transgender Discrimination

Transgender people report discrimination in every setting you can imagine. They are harassed or discriminated against at home, at school, at work, and even in doctor's offices. They also face an increased risk of suicide and depression.3????

They also experience disproportionate rates of various diseases, including HIV. These burdens are even more intense for transgender people of color. Unfortunately, many people are unaware of transgender issues and the discrimination they face.

Some places where transgender people face stigma and discrimination include:


People who are transgender often face challenges that make it difficult to access the healthcare services that they need to support physical and emotional well-being. This includes:

  • Lack of insurance coverage to provide gender-affirming care
  • Low knowledge of transgender issues among healthcare providers
  • Denial of care
  • Interpersonal stigma
  • Mistreatment
  • Refusal to use the preferred name or pronouns

In one national survey of more than 6,000 transgender individuals, 19% had experienced being refused care. The results also indicated that 28% had been harassed and 2% had experienced violence while in a medical setting.4

Public Accommodations

Transgender people are often targeted by discriminatory legislation. For example, while there has been a push for equal accommodation laws, many people are unfortunately deeply opposed to these laws.

Equal accommodation laws are designed to allow transgender individuals to access the bathroom concordant with their gender identity. This means that transgender women can use the women's bathroom and transgender men can use the men's bathroom.

Access to Services

Transgender women also face stigma and discrimination when accessing social services. For example, research suggests that only 30% of women's shelters in the U.S. are willing to accept and house trans women.5

In 2012, the U.S. Department of Housing and Urban Development (HUD) passed an Equal Access Rule to ensure that all HUD-assisted programs were open to all individuals regardless of their gender identity. In 2020, however, a proposed change would have allowed sex-segregated shelters to discriminate against transgender people.6

This places vulnerable women in danger because trans women are also at a higher risk of unemployment and homelessness due to trans discrimination.

Why Trans Women Face Stimga

While all transgender people face stigma, research suggests that trans women experience such discrimination at higher rates. For example, one study found that trans women tend to experience greater social stigma than trans men and that this stigma largely stems from cisgender men.7

Some explanations for this stigma include:

Gender Panic

Gender panic refers to the threat that many people believe exists when transgender women are allowed to enter women’s-only spaces such as bathrooms. Rarely or never are similar concerns expressed about transgender men accessing men’s-only spaces.

This is presumably because women are considered to be more vulnerable to being taken advantage of in a way that men are not. Similarly, transgender men are not seen as potential predators in the same way as transgender women, due to their early life female socialization.

These concerns are fundamentally based on how our society talks about sex and gender. Our cultural norms assume that cis men are naturally disposed to being sexually aggressive and predatory. They also assume that cis women have little ability to resist.

Transgender women are women. They are also far more likely to experience sexual assault than commit it. In fact, their rates of sexual victimization are much higher than those of cis women. (Cis women are women who are assigned female at birth.)

Rape Culture and Trans Misogyny

The way that femininity is associated with sexual vulnerability in American culture means that the transgender women who are being framed as a threat by anti-accommodation activists are themselves often afraid of sexual victimization once they’ve transitioned and are living as women.

The problematic assumptions are components of what is often called rape culture. Fortunately, they can be addressed through education and changing cultural norms.

Society must do a better job of teaching that just because someone is raised as male, they will not necessarily be sexually predatory. We must also do a better job of teaching that women have both power and agency in their own sexuality.

Doing both these things would not only be helpful for society at large. It could also potentially reduce the perceived threat associated with transgender women who may be presumed unable to shed the psychological history of a masculine birth. Cultural education about gender identity could also help with these fears.

A Word From Verywell

Equal accommodation laws are beneficial to the transgender population without posing significant financial or other difficulties to the population as a whole. Fortunately, history suggests that the best way to deal with discrimination based on moral panic is to reduce the legal acceptance of discrimination and segregation rather than enabling or tolerating it.

Research also suggests that social and peer support as well as constructive coping skills could help combat some of the effects of stigma transgender people face.7


Online Transgender Support Groups

Get the help you need.

Our editors independently research, test, and recommend the best products; you can learn more about our review process here. We may receive commissions on purchases made from our chosen links.

Transgender people are individuals whose gender identity is different from the one they were assigned at birth. (Cisgender people are those whose gender identity is what is assigned when they are born.) All transgender people, including both binary and nonbinary individuals, can experience significant stress moving through a world that treats being cisgender as the norm and lacks understanding about what it means to be trans. Having other people to talk to can make a big difference in your ability to cope.

It is essential to know that many online transgender support groups are closed or restricted. You may be asked to affirm your identity before joining one of them. Additionally, some groups are by invitation only and may require networking for accessibility.

We've rounded up the best online transgender support groups so you can find the right one for your needs.

If you need immediate support in a time of crisis, please contact Trans Lifeline - 877-565-8860 or the Trevor Project Lifeline - 866-488-7386 or text "Start" to 678678

The 5 Best Online Transgender Support Groups of 2021

Trans Lifeline - Best Overall

Sign Up Now

Trans Lifeline is a peer-support service run by trans people for trans people. All of the operators who work for the hotline are transgender.

While it started as a service for people in crisis, that is no longer the case. Trans Lifeline still functions as a crisis and suicide prevention hotline. However, it also serves as a space for trans people who just need someone to talk to.

Trans Lifeline provides live, one-on-one phone support, as well as large numbers of online resources for transgender and gender-questioning individuals. The hotline is open 24 hours a day. It is only guaranteed to be staffed from 10 a.m. to 4 p.m. Eastern time, but operators are often also available at other times.

In addition to information resources, Trans Lifeline offers microgrants to individuals who need financial support when updating their name and gender on their legal documents. They accept a limited number of applications each month. However, they will pay the entire fee for most document changes other than birth certificates.

The Trevor Project- Best for young people in crisis

Sign Up Now

The Trevor Project began from a film, the Academy Award-winning Trevor.

When the movie was released, the creators soon realized a need for resources to support lesbian, gay, bisexual, and transgender youth. To address this need, they created The Trevor Project.

The Trevor Project offers several support resources for LGBTQ+ youth. There is a crisis hotline called TrevorLifeline and a secure instant messaging service called TrevorChat. The site provides access to trained specialists via cellphone using TrevorText. Finally, the Trevor Project offers TrevorSpace, a social networking site for LGBTQ+ individuals under 25, as well as their friends and allies.

Also, to support resources for LGBTQ+ youth, The Trevor Project offers educational resources for teachers and other professionals who work with youth. They also provide materials to help schools develop comprehensive suicide prevention policies that address kids' needs.

Transbucket Best for support around surgical transition

Sign Up Now

Transbucket is primarily an online resource for learning about gender-affirming surgery. It is restricted to only members of the transgender community. Transbucket is inclusive of both binary and nonbinary trans people.

On Transbucket, you can find stories about people’s experiences undergoing various types of gender-affirming care. You can learn about different surgeons. You can also see photos that people have shared of their results and ask questions about their experiences getting surgery.

Although it is not a traditional support group, Transbucket is a great place to learn about gender-affirming care. While not a substitute for a doctor’s advice, Transbucket can give you a window into what it’s actually like to get different types of surgery. It may also provide a broader range of good and bad results than you are likely to see at a surgeon’s office.

Gender Spectrum - Best for teens and their parents

Sign Up Now

Gender Spectrum is an organization built to “create gender-sensitive and inclusive environments for all children and teens.”

The service is best-known for its annual conference and its extensive selection of training and other resources for youth, their families, and the professionals working with them. However, Gender Spectrum also offers online groups for pre-teens, teens, parents, caregivers, and other family members. Even better, Gender Spectrum offers a Spanish-language support group for parents of Latin trans youth.

Gender Spectrum primarily offers generalized support groups for transgender youth and their families. However, the organization also occasionally offers topic-specific support groups for caregivers.

To participate in a group, you will have to register. Groups are held at specific times and take place over one or more sessions. For some groups, you can attend once or multiple times over a month. For others, you are expected to attend for an entire series.

Groups are organized by population. They are generally facilitated by one or more trained staffers who may or may not be part of the transgender community. All pre-teen groups are led by trained volunteers or Gender Spectrum staff.

The Tribe - LGBTQ+ Group - Best for mental health

Sign Up Now

There aren’t many transgender-specific support groups for people looking for help dealing with mental health concerns.

However, lesbian, gay, and bisexual individuals face some of the same issues moving through the world, as do their transgender counterparts. Therefore, sometimes an LGBTQ+ support group can be a good option. This is particularly true for individuals whose concerns are less about their gender and more about other stress types.

The Tribe offers an LGBTQ+ peer-to-peer support group, and by using this site, there are several ways of getting support. You can either post in a group forum, or you can chat live with other members of the group. You can also participate in a range of wellness activities. While not transgender-specific, these activities can help you develop coping skills and otherwise work to improve your mental health and wellbeing.

Most of the resources from The Tribe can be accessed either on a desktop or a mobile device, which makes it ideal when you’re around and about.


What Does It Mean to be Transgender?

Gender identity is a person’s internal sense of themself as male, female, or a different gender. People sometimes refer to the “transgender umbrella” as including all individuals who have a gender identity separate from that which would be expected for their assigned sex at birth. This includes individuals who have a binary identity, such as transgender men assigned female at birth. It also includes people who are non-binary, genderqueer, or agender.

What Do Transgender Support Groups Offer?

Transgender support groups offer people a chance to connect and discuss similar life experiences and challenges. Sometimes, when you are a member of a minority group, it can be helpful to talk to people who will understand those parts of your life without needing an explanation.

Transgender support groups can be a great place to find people who understand you and make you feel less alone. They can serve as resources in a time of crisis or just a place to find a sympathetic ear if you’re having a bad day.

How Can Transgender Support Groups Help You?

Transgender people may experience somewhat unique challenges to others who share a similar gender identity or life stage. That is true whether you’re a teen just trying to figure out how to come out to your parents or an older person struggling to fit into an assisted living community.

Being a part of a support group can help you find resources to cope with problems, whether large or small. They can also help you feel useful and needed by giving you a chance to support others. Everyone has different experiences, knowledge, and skills. A transgender support group can be a way to feel better about your life, not just by getting help but by helping others.

Why Do Transgender People Have An Increased Risk of Mental Health Problems?

In general, transgender people have an increased risk of mental health problems.1 This is not because being transgender is bad or wrong. It is because people who are transgender often experience stigma and or discrimination. These experiences are associated with an increased risk of depression and anxiety. They may also increase a person’s risk of developing problematic coping skills such as smoking or substance use.2

Why You Should Trust Our Recommendations

The author of this guide is a licensed, independent clinical social worker who works in a hospital-based transgender health program. She has published extensively about gender health and routinely provides online supports to her patients. The resources included in this guide were selected to include the most-respected, publicly available online support groups.

Stop asking me if my eight-year-old trans kid is just going through a phase - 3/30/21

Accepting that my kid is trans was easy. Dealing with others' skepticism that he is who he says he is? Not so much.

The night my kid came out as transgender was a night like all the others last summer. After a long cottage day spent climbing trees and doing daredevil jumps off the water trampoline, Zack (then still using his feminine birth name) informed us at bedtime, “I’m a boy.” Standing in his bedroom doorway, his beloved stuffed giraffe hanging from his fingers, it was as offhanded and unexpected as if he’d declared he flossed his teeth.

“OK,” I replied. I kissed him goodnight and went to my bedroom. “Zack’s a boy,” I said lightly to my husband, matching my tone to Zack’s. Josh matched his to mine. “OK.” Then, “Wanna watch a Killing Eve?”

It might sound like we were being dismissive, or perhaps that we were in denial. We certainly weren’t yet educated enough to know that with strong parental support, suicide rates for trans youth plummet. It’s simply that we were taking our emotional cues from an eight-year-old, as we still are when it comes to Zack’s identity.

The highly dubious case against unconditional acceptance

There is a chorus of voices cautioning against the instant and unconditional acceptance that Josh and I gave Zack. They’re concerned that young girls, influenced by social media to think they’re trans when they’re really just confused, are rushing into life-altering changes they’ll come to regret.

There has always been transphobia, but this particular moral panic is rooted, I believe, in a study published in 2018. An American researcher looking into kids who suddenly and without warning manifested symptoms of gender dysphoria blamed it mostly on social media and peer pressure: a trend, spreading among friends like a love of Doc Martens or Harry Styles. She named the phenomenon “rapid-onset gender dysphoria” (ROGD).

Despite biases in the research methods (the parents were recruited through websites known to amplify concerns about the rise in trans-identifying youth, and none of the kids in question were surveyed, only their parents), and despite a post-publication review of these biases, the study was picked up by both conservative and mainstream media. True or not, its key claim—that being trans is a social contagion—settled in the collective memory.

This past summer, ROGD was in the news again, with the release of a book warning of a “transgender craze seducing our daughters.” It doesn’t change my opinion of Zack but I wonder if it will change other people’s. I wonder if other parents like me are worrying, not just about whether our trans kids will be bullied, but whether they’ll be believed. It’s no surprise to me that some of us, when coming out to family and friends, mount offensive campaigns, proactively itemizing all the ways over all the years that our kids hinted at their true selves.

This was the approach taken by two Vancouver moms who co-host a podcast in which they share their experiences parenting their young, trans sons. In one of the episodes, they each read the coming out letters they wrote to family and friends. The letters seem written specifically to counter potential ROGD-based objections; they reference scientific studies, quote statistics and even include PDF attachments. One letter ends with the plea, “We ask you, from the bottom of our hearts, for your full support and unconditional love for [our son].”

I resent the culture of fear and doubt that makes parents feel they have to be as strategic as those podcast hosts, submitting proof that our kids are who they say they are. I resent the implication, even though I know it’s false, that I’m causing my son harm by supporting his transition. I resent the energy I’m spending separating trans facts from transphobia.

So when it came time for my family’s own coming out, I chose not to write a pre-emptive letter. I chose not to ask the people I support and love to give their support and love to Zack. Just as Zack trusted his parents and his friends with his news, I chose to trust mine. The phrase “expect acceptance” echoed in my head, like a mantra. Assume people will be kind. Expect acceptance.

“Expect acceptance” was the theme of Angela Swan’s keynote when I heard her speak at an event in 2019. Swan told of her experience coming out as trans, and transitioning from male to female, while working at a downtown Toronto law firm during a time much less tolerant than today. She was frank about the challenges she faced, but overall she was hopeful. It feels better, she suggested, to expect acceptance than it does to brace for bigotry.

With Swan’s words as our north star, our family’s approach is to treat Zack’s transness like the non-issue it is. We address it when it comes up (the Rosh Hashanah Zoom call, Zack’s first session with his speech therapist after summer break), but it’s never our lead story. I try not to make it an open conversation that leaves room for questions. I try to model with my nonchalant telling of Zack’s news the nonchalant response I expect to receive. “By the way,” I find myself saying to other parents in the schoolyard, just as I said to Josh, “Zack is a boy.”

“Were there signs? What if it’s a just a phase?”

Still, people are curious. Or skeptical. I can’t tell which. Were there signs? they ask. When his sister, Charlie, took ballet, Zack opted for hip hop. He always preferred pants to dresses. And he likes skateboarding, video games and fart jokes. But so do lots of girls. Josh and I are urban, liberal and agnostic enough not to think there’s anything unusual—nothing gender nonconforming—about a girl who likes Lego and is good at puzzles.

Were there signs? Even when it’s well-intended and asked by people who have never heard of ROGD, this question activates my fight or flight reflexes. It feels like what they’re really saying is, “Are you sure it’s not just ROGD? If there weren’t any signs, then maybe he’s just confused. Maybe he’s just a lesbian. Maybe you shouldn’t rush into anything.” Frankly, it doesn’t matter to me whether there were signs. Why does there have to be a warning? Why do ROGD proponents believe trans identities have to be premeditated to be valid?

My kids’ hearts are fickle but true. After years of happily attending Charlie’s dance and art classes, there were no signs before Zack asked to try rock climbing. Yet we didn’t worry whether it was a true passion or a passing fancy, or if he’d get hurt. We simply enrolled him in a climbing program, bought him some hand chalk and sent him to the gym with our most sincere wish: darling boy, ascend.

What if it’s a phase? What if he changes his mind? Those are other questions people ask, although I think they’re more relevant for older kids whose transitions can include permanent medical interventions like hormone therapy and surgery. Zack’s not eligible for hormone therapy until he’s 12, not eligible for surgery until 16. By then, if his gender identity has been “insistent, persistent and consistent,” as his doctor and therapist have told us is key, then under their supervision, Josh and I will support whatever gender-confirming treatment Zack chooses. In the meantime, he’s free to dress, act and be however and whoever he wants. Notably, he doesn’t want to be anyone other than who he is.

What if it’s a phase? If it’s a phase, like his love for the DJ Marshmello, or for green peppers, we will let Zack guide us out, the same way he guided us in. Rock climbing, maybe, is also a phase. After two years at the climbing gym, and again without warning, Zack has told us he wants to learn to play drums: “It’s loud and it’s noisy and it seems fun.” I love that Zack is curious about new activities and exploring new aspects of his identity so I will sign him up for drum classes when registration opens this summer—if he’s still interested.

Education and support are critical

The question I had is for Zack, because I wanted to better understand his origin story, was how he even knew transgender was a thing he could be?

“From the Rainbow Alliance,” he replied. The Rainbow Alliance is a club at Zack’s elementary school, open to students in grades 4 to 6, that helps kids become advocates and allies for sexual and gender diversity. The students in the club have decorated the bulletin board outside Zack’s classroom: There are multi-coloured fists, pointing skyward as symbols of strength; hand-drawn letters, along with a computer-printed definition, for each word that forms the LGBTQ2SIA+ acronym; a pronoun primer; even tips for how to “degender your language.”

I’m grateful for the teacher who leads the Rainbow Alliance for giving Zack the word to name his feelings and his identity. I’m grateful for all the leaders making mirrors—TV shows, YouTube videos, books, bulletin boards—in which kids like mine can see themselves reflected. Seems to me that these educational and representational efforts—and not ROGD—may be the reason that more young people than ever are identifying as trans; according to a recent Gallup poll, almost half of trans Americans are aged 19 to 24. Mostly I’m grateful for Zack’s friends. They make him feel safe and supported, and they know, instinctively, that Zack is Zack, whatever pronouns or bathroom he uses.

After months of closure, the kids’ program at the climbing gym is re-opening soon. Zack, it turns out, is excited to get back on the rock wall. “Don’t you get scared,” I ask him, “being up so high?” Despite knowing the gym uses a belay system for safety, I certainly get scared sometimes, thinking of him hanging, 30 feet above the ground.

“I’m not scared at all,” is Zack’s confident reply. “I know that if I fall, I’m attached to a buddy.”

Americans Strongly Support Trans Rights — In Some Cases 5/26/21

Americans strongly support trans service members being in the military — even as they say trans athletes should compete in sports according to the sex listed on their birth certificates, according to a new Gallup survey.

In the survey, 66% of respondents said they're in favor of openly transgender men and women serving in the U.S. military. But only 34% said trans athletes should be allowed to compete in sporting events that match their gender identity.

The survey, which was performed earlier this month, reflects Americans' "mixed views" on trans issues, Gallup says. The numbers didn't surprise Imara Jones, a journalist who is the creator of TransLash Media.

"Americans are deferential to the armed forces and have faith that if the armed forces set a standard and if people have met that standard, that people should be allowed to serve," she says.

Sports bans on trans athletes, on the other hand, are "a solution in search of a problem," Jones says, noting the small minority of transgender people in the United States.

More than 30 states have introduced bills that would ban transgender female athletes from participating in girls' and women's school sports, and a handful have approved absolute bans on trans athletes.

Referring to the recently lifted ban that kept transgender people from serving in the military, Jones says, "I think as [people] begin to spend more time on it and focus on it, that we'll see a similar reversal" on sports bans targeting transgender athletes.

"I think that that was one of the issues with the trans military ban," she says, "that this was not an issue that the military brought up, nor service members."

It remains to be seen, Jones says, if people who are still forming their opinions about trans athletes will defer to the authorities in sports. After all, she says, schools and athletic associations were studying these issues for years before they became hot-button topics.

"These organizations have said that trans people should be allowed to compete in sports which match to their gender — that there is no impact, no difference," Jones says.

In recent years, shifts in attitudes about gender and trans rights have been led by younger generations. But the poll found most young people think trans athletes should compete according to the sex listed on their birth certificates.

In the poll, 50% of Americans who are ages 18 to 29 said they have trans friends, relatives or co-workers in their lives — a far higher percentage than any other age group. Respondents were more likely to back trans service members and athletes if they have a trans person in their lives.

Despite that dynamic, 59% of people in the 18-29 age group said trans athletes should compete according to the sex listed on their birth certificates — a percentage that's slightly higher than among the 50-64 age group, of which 58% said the same.

As Gallup puts it, "changes in views on LGBT issues are often driven by generational change, and at the moment, young Americans hold views similar to their elders'."

Many Americans had not considered trans issues until recently. As Jones notes, most people in the U.S. don't have any direct experience with a trans person.

Lots of Americans are figuring out what they think about trans issues — which they maybe had never thought about until a few years ago. What should people be thinking about as they navigate these ideas?

When asked what Americans should do to help them navigate the ideas that are now percolating in our society, Jones says they should start with education.

"You should seek trans resources or voices," she says. "There are so many online, from the Transgender Law Center to The Trevor Project to the Trans Journalists Association. You should learn about the issue first before you make up your mind."

Jones adds, "I think that people come to flip decisions on this because it's not something that they spent a lot of time thinking about."

A Researcher Is Trying To Settle The Transgender Athlete Debate — Using Science

The debate on whether transgender females should be allowed to play women's sports has become increasingly politicized. One transgender athlete and researcher is forging a middle ground with science.

The debate over whether transgender female athletes should be allowed to play girls' and women's sports has exploded this year. More than 30 states have introduced bills that would ban them from participating. The issue is emotionally charged, and it's hard to find a middle ground. But NPR's Tom Goldman reports on a pioneering researcher trying to get there.

TOM GOLDMAN, BYLINE: With the simple act of signing his name, Mississippi Governor Tate Reeves turned the debate over transgender female athletes into reality.

TATE REEVES: Senate Bill 2536, the Mississippi Fairness Act, is now law.

GOLDMAN: The law, banning transgender athletes from high school and university female teams, is scheduled to take effect this year. The legislation Reeves signed in March and other similar state bills cite science to make the case that after puberty, transgender female athletes have an absolute advantage over cisgender female athletes, even after therapy to reduce the powerful hormone testosterone. And therefore, the trans athletes should be banned from female sports. But none of the lawmakers behind these bills reached out to Joanna Harper.

JOANNA HARPER: My official title is Ph.D. researcher at Loughborough University.

GOLDMAN: Unofficially, Harper is a scientist in the middle of a debate that's being waged at the angry extremes between those who want to ban and those who want blanket inclusion - any person who identifies as female can play women's sports. The banning side doesn't want to hear this.

HARPER: In most sports, after hormone therapy, it is perfectly reasonable to allow trans women to compete against cisgender women.

GOLDMAN: That's because the therapy, Harper says, can make the playing field more level, even though trans women still can retain advantages like strength and size after transitioning. She believes hormone therapy should be required at high levels of sport, and that restriction angers some on the other side.

HARPER: There are people who consider me a traitor to trans people.

GOLDMAN: What she is is a pioneer in transgender research, which Harper never intended to be. Seventeen years ago, she started taking pills to add estrogen and block testosterone as part of her transition from male to female. She also prepared to change athletically. At one time, she was ranked among the top male distance runners in her native Canada.

HARPER: Within nine months of starting hormone therapy in 2004, I was running 12% slower.

GOLDMAN: Which both bothered her as a competitor and intrigued her as a scientifically curious person - so she started collecting data. She got race teams from eight transgender women before and after hormone therapy. One of the effects of reducing testosterone is reducing hemoglobin, which carries oxygen-rich red blood cells throughout the body. It provides fuel for endurance athletes. And with less, the athletes slow down, which is what happened in Harper's study. Collectively, the women were more than 10% slower after therapy.

HARPER: And that's an important number because that's the difference between serious male distance runners and serious female distance runners - 10- to 12% sort of range.

GOLDMAN: In 2015, she published her data in the first paper on transgender athletes. She then wrote the book "Sporting Gender" and helps sports organizations like the International Olympic Committee craft policies in the middle - inclusive of transgender female athletes and restrictive by requiring them to undergo hormone therapy. Dr. Eric Vilain, a Washington, D.C.-based geneticist and expert on sex differences, said Harper's research has been groundbreaking.

ERIC VILAIN: Looking at data on trans athletes, I don't see that there is any kind of fear to have that suddenly the world of sports is going to be topsy-turvy and very unfair for all women out there.

GOLDMAN: It's harder to assess the impact with younger trans athletes. High schoolers develop at different rates, making it tough to create one-size-fits-all rules. Plus, the numbers are so small. Harper says transgender people make up less than 2% of the population, and trans kids are one-sixth as likely as cisgender kids to go out for school sports. Still, the debate rages, and Harper's goal of pulling people toward the middle continues. Since 2019, she's been at Loughborough University, a prominent sports science school in England. Harper says the science of transgender athletes still is in its infancy. She's broadening her research to different sports, fueled by a personal mantra - more data will lead to better policies.

Suicide Thoughts and Attempts Among Transgender Adults

Findings from the 2015 U.S. Transgender Survey - September 2019

Studies show that the prevalence of suicide thoughts and attempts among transgender adults is significantly higher than that of the U.S. general population. Using data from the 2015 U.S. Transgender Survey, this report examines key risk factors associated with suiciality among a sample of transgender people.

  • 98% of respondents who had experienced four instances o discrimination and violence in the past year thought about suicide that year
  • 51% of them attempted suicide in that year.
  • 13% of respondents who had been denied equal treatment because they are transgender report suicide attempts in the past year
  • 6% of those who ha not experienced such treatment reported past year attempts.
  • 11% of respondents who had been rejected from their families reported past year suicide attempts
  • 5% of those who had not experienced such rejection reported attempts in the past year
  • 30% of respondents who were physically attacked in a public place reported attempting suicide in the past year
  • 7% of those who were not similarly attacked reported past year attempts
  • 9% of respondents who wanted but did no receive gender-affirming care reported past-year suicide attempts.
  • 5% of those who wanted and received gender affirming care reported attempts in the past year.

Executive Summary

Over the past 20 years, a growing body of research has focused on suicidality among transgender individuals, including prevalence estimates and risk factors associated with suicide thoughts and attempts. Studies of the transgender population demonstrate that the prevalence of suicide thoughts and attempts among transgender adults is significantly higher than that of the U.S. general population. For example, transgender adults have a prevalence of past-year suicide ideation that is nearly twelve times higher, and a prevalence of past-year suicide attempts that is about eighteen times higher, than the U.S. general population. The 2015 U.S. Transgender Survey (USTS), which is the largest survey of transgender people in the U.S. to date, found that 81.7 percent of respondents reported ever seriously thinking about suicide in their lifetimes, while 48.3 percent had done so in the past year. In regard to suicide attempts, 40.4 percent reported attempting suicide at some point in their lifetimes, and 7.3 percent reported attempting suicide in the past year.

Although the research literature to date agrees that transgender people are at an elevated risk of suicide thoughts and attempts, there is still much to learn about why transgender people are particularly at risk. In this report, we utilize data from the 2015 USTS to examine the key risk factors associated with lifetime and past-year suicide thoughts and attempts among a large and diverse sample of transgender people.


Demographic trends related to suicide thoughts and attempts among USTS respondents reflected trends found in prior research of suicidality in the U.S. general population and among transgender people.

  • Among USTS respondents, suicide thoughts and attempts were more likely to be reported among those of younger ages, Alaskan Native/American Indian or Biracial/Multiracial respondents, transgender men, pansexual respondents, and non-binary respondents assigned female at birth.
  • Similar to trends in the U.S. population, we found a higher prevalence across all suicide-related measures among respondents who had lower educational attainment, were unemployed, or had lower annual household income. In terms of relationship status, respondents who were partnered and living together with their partners had the lowest prevalence of suicide thoughts and attempts.

General Risk Factors

Transgender people have many of the same risk factors for suicidality as found in the U.S. general population, such as depression, substance use, and housing instability. Similar to these trends in the U.S. general population, we found an elevated prevalence of suicide thoughts and attempts among USTS respondents who:

  • Experienced serious psychological distress and reported heavy alcohol or illicit drug use (excluding marijuana);
  • Reported poor general health compared to those who reported excellent health (19.9% versus 3.6% past-year suicide attempts);
  • Reported having a disability, experienced homelessness in the past year, or had ever been arrested for any reason.

Unique Risk Factors

In addition to general risk factors, transgender people have additional risk factors, such as experiences of discrimination, stigma, family rejection, and lack of access to gender-affirming health care. Findings regarding these unique factors include the following:

  • Experiencing discrimination or mistreatment in education, employment, housing, health care, in places of public accommodations, or from law enforcement is associated with a higher prevalence of suicide thoughts and attempts. For example, the prevalence of past-year suicide attempts by those who reported that they had been denied equal treatment in the past year because they are transgender was more than double that of those who had not experienced such treatment (13.4% compared to 6.3%).
  • Those who reported that their spouses, partners, or children rejected them because they are transgender reported a higher prevalence of lifetime and past-year suicide attempts. Those
  • who reported rejection by their family of origin, for example, reported twice the prevalence of past-year suicide attempts compared to those who had not experienced such rejection (10.5%compared to 5.1%).
  • Respondents who had been rejected by their religious communities or had undergone conversion therapy were more likely to report suicide thoughts and attempts. For instance, 13.1 percent of those who had experienced religious rejection in the past year had attempted suicide in the past year; by contrast, 6.3 percent of respondents who had experienced religious acceptance in the past year attempted suicide in the past year.
  • Experiences of violence, including intimate partner violence (IPV) are associated with higher prevalence of suicide thoughts and attempts. Over 30 percent of those who were physically attacked in a place of public accommodation reported attempting suicide in the past year, which is over four times the prevalence among respondents who were not similarly attacked.
  • Those who had “de-transitioned” at some point, meaning having gone back to living according to their sex assigned at birth, were significantly more likely to report suicide thoughts and attempts, both past-year and lifetime, than those who had never “de-transitioned.” Nearly 12 percent of those who “de-transitioned” attempted suicide in the past year compared to 6.7 percent of those who have not “de-transitioned.”
  • People who are not viewed by others as transgender and those who do not disclose to others that they are transgender reported a lower prevalence of suicide thoughts and attempts. For instance, 6.3 percent of those who reported that others can never tell they are transgender attempted suicide in the past year compared to 12.2 percent of those who reported that others can always tell they are transgender.
  • The cumulative effect of minority stress is associated with a higher prevalence of suicidality. For instance, 97.7 percent of those who had experienced four discriminatory or violence experiences in the past year (being fired or forced to resign from a job, eviction, experiencing homelessness, and physical attack) reported seriously thinking about suicide in the past year and 51.2 percent made a suicide attempt in the past year.

We also found that there are some factors that are associated with lower risk of suicide thoughts and attempts for USTS respondents:

Respondents with supportive families reported lower prevalence of past-year and lifetime suicide thoughts and attempts.

  • Those who wanted, and subsequently received, hormone therapy and/or surgical care had a substantially lower prevalence of past-year suicide thoughts and attempts than those who wanted hormone therapy and surgical care and did not receive them.
  • A lower proportion of respondents who lived in a state with a gender identity nondiscrimination statute reported past-year suicide thoughts and attempts than those who lived in states without such a statute.

Our findings underscore the urgency of research to identify promising intervention and prevention strategies to address suicidality in this population. USTS respondents have the elevated risk of suicide thoughts and attempts that one would expect based on general risk factors that affect the U.S. population, such as substance use and serious psychological distress. Yet, it’s clear that minority stress experiences, such as family rejection, discrimination experiences, and lack of access to gender-affirming health care, create added risks for transgender people. Furthermore, the cumulative effect of experiencing multiple minority stressors is associated with dramatically higher prevalence of suicidality. Future research that supports the design and evaluation of suicide intervention and prevention strategies for the transgender population is urgently needed.

New Study Reveals Shocking Rates of Attempted Suicide Among Trans Adolescents

Harrowing statistics from a study recently published by the American Academy of Pediatrics revealed alarming levels of attempted suicide among transgender youth -- with the highest rates among transgender boys and non-binary youth. The findings emphasize the urgency of building welcoming and safe communities for LGBTQ young people, particularly for transgender youth.

More than half of transgender male teens who participated in the survey reported attempting suicide in their lifetime, while 29.9 percent of transgender female teens said they attempted suicide. Among non-binary youth, 41.8 percent of respondents stated that they had attempted suicide at some point in their lives.

Many transgender young people experience family rejection, bullying and harassment, or feel unsafe for simply being who they are - all of which can be added risk factors for suicide. Earlier this year, HRC released its 2018 LGBTQ Youth Report, which detailed similarly alarming experiences -- but also significant perseverance among LGBTQ young people in the face of daunting challenges.

There are steps that can be taken to help prevent this tragedy.

HRC Foundation’s Welcoming Schools program provides specific guidance to parents, teachers and the wider community for preventing anti-LGBTQ bullying and aggression in schools. This can be as simple as responding appropriately to anti-LGBTQ comments in the classroom, or encouraging educators to promote inclusivity and diversity in their lesson plans.

Parents and families can start by learning the facts and educating themselves about issues that impact LGBTQ youth. Whether or not families have openly LGBTQ children, it is vital to make home a safe and affirming space for all identities.

If you or someone you know may be at risk of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text SOS to 741741 the national Crisis Text Line.. If you’re a young LGBTQ person and need to talk to someone, call The Trevor Project’s 24-hour crisis hotline for youth at 1-866-488-7386 or text START to 678678. If you are a transgender person of any age, call the Trans Lifeline at 877-565-8860.

Why do Transgender People Die by Suicide?

The following are six risk factors that providers should be aware of and assess in order to better understand suicide risk in their TGD patients.

Risk Factor #1: External minority stress

Factors studied under this category include various types of violence, discrimination, harassment, and rejection based on one’s minority gender identity. These factors are consistently positively related to suicidal thoughts but less so to suicidal behaviors. Factors most highly related to suicidal thoughts include harassment, discrimination, social stressors such as rejection, and non-affirmation in one’s identity. The experiences of physical and sexual violence are related to both suicidal thoughts and behaviors.

Risk Factor #2: Internal minority stress

These factors are unique to TGD individuals and are experienced more internally compared to the experience of discrimination or violence. These factors include internalized stigma/transphobia (e.g., shame about being transgender), concealment of identity/nondisclosure, expectations of social rejection, an inability to express gender, negative self-concept, and an unclear gender identity. These factors appear to be particularly implicated in the vulnerability for suicidal thoughts but less so for suicidal behavior once suicidal thoughts have developed.

Risk Factor #3: Psychiatric morbidity

As to be expected, mental health problems relate to suicidal thoughts and behaviors within this population. These include depression, loneliness and isolation, emotional instability, anxiety, PTSD, alcohol and drug abuse, physical and mental disabilities, and learning disabilities. Some risk factors are more strongly related to suicide attempts than others. For example, factors such as substance abuse and PTSD are slightly more closely related to suicidal behavior compared to internal factors such as loneliness.

Risk Factor #4: Transition and healthcare

Gender transition is a unique experience for each individual who chooses to, or chooses not to, go through the process. There are many steps in the transition process ranging from social transition (e.g., dressing as one’s gender) to medical interventions (e.g., hormone therapy or surgical interventions). The following factors fall into the transition and healthcare risk category, and relate to suicidal thoughts and behaviors in TGD adults: not completing hormone therapy, lack of medical interventions such as breast or genital surgery, lack of social transition or living every day in one’s real gender, lack of identity documents that align with identified gender, health care coverage for gender-related interventions, lack of psychotherapy for gender dysphoria, and visual nonconformity.

Risk Factor #5: Reasons for living

Reasons for living are often protective against suicidal thoughts and include religiosity, optimism, survival coping beliefs, concerns about how loved ones will react to one’s suicide, fear of suicide, fear of social disapproval if one attempts suicide, and moral objections to suicide.

Risk Factor #6: Demographics

The more static/demographic risk factors for suicide among TGD individuals include assigned female sex at birth, gender self-identification as male, and childhood gender nonconformity. Other demographic factors related to suicidal thoughts include younger age, being a racial or ethnic minority (though there are mixed findings on this), education, income, employment, socioeconomic status, sexual orientation as gay, lesbian, bisexual, or unsure sexual orientation.

Awareness and inclusion of these risk factors in patient assessments can increase the effectiveness of suicide prevention efforts within TGD individuals.




Gender-Affirming Chest Surgeries Increase by Nearly 5x in Teens - 10/17/22

Researchers compared number of annual surgeries in 2016 to 2019.

Numbers of gender-affirming chest surgeries among transgender adolescents jumped 389% from 2016 to 2019, researchers reported.

Drawing on data from the Nationwide Ambulatory Surgery Sample, an estimated 1,130 chest reconstructive surgeries were performed on transgender and gender-diverse (TGD) adolescents during these years, Rishub Karan Das, BA, of Vanderbilt University School of Medicine in Nashville, and colleagues found.

Nearly all were masculinizing (chest reconstruction (e.g., mastectomy), with only 1.4% feminizing (chest reconstruction (e.g., augmentation mammaplasty) the group wrote in a research letter appearing in JAMA Pediatrics.

Only about 100 of these surgeries were performed in 2016, after which they steadily became more popular, surpassing 200 surgeries in 2017 and 300 by 2018. Das and colleagues put the 2019 total at 489 (P<0.001 vs 2016).

Ages of the adolescents ranged from 12 to 17, with a median of 16.

For context, the researchers noted that approximately 300,000 adolescents between the ages of 13 and 17 identify as transgender in the U.S. today.

"Reconstructive genital surgery is typically not performed in adolescents, but masculinizing chest reconstruction (e.g., mastectomy) and feminizing chest reconstruction (e.g., augmentation mammaplasty) may be performed in outpatient and ambulatory surgery settings," the researchers explained

A slew of recent data has suggested that gender-affirming care -- even in early adolescence -- is linked to improved mental health for TGD individuals. But this care has been put in jeopardy with many states recently introducing bills to block this gender-affirming care for youth.

Only 19.9% of adolescents who underwent gender-affirming chest surgeries in this sample also used gender-affirming hormone therapy.

As for psychiatric comorbidities, 21.1% had anxiety and 16.2% had depression -- the two most commonly reported.

Most surgeries (61.1%) were covered by private insurance. A total of 16.5% of individuals used public health insurance to cover the cost of surgery and 15.8% were self-pay. These percentages didn't change much during the study period. "Most TGD adolescents had either public or private health insurance coverage for these procedures, contrasting with the predominance of self-payers reported in earlier studies on TGD adults," Das and colleagues pointed out.

The median inflation-adjusted total cost of gender-affirming chest surgeries largely held study during this time period, at about $30,000 (interquartile range $21,285-$45,147). That being said, over half of those opting for gender-affirming chest surgeries had a family income over $82,000 annually.

Not surprisingly, there were wide racial disparities among surgery patients: in 2019, 77.9% were white, 12.2% were Hispanic, 2.7% were Black, 2.5% were Asian or Pacific Islander, and 0.5% were Native American. Around 4% were categorized as "other race."

Most adolescents included in the analysis lived in a densely population area -- 68% living in a county with over 1 million residents. Trending down from there, 21.9% lived in a moderately densely populated area and only 9.8% lived in a county with less than a quarter million residents.

FULL See more here