Young Transgender Women Burdened with High Rates of Psychiatric Diagnoses


New research published in JAMA Pediatrics reveals that transgender women have more than double the prevalence of psychiatric diagnoses than the general US population. The study found that the women, who had been assigned male at birth and now identified as female, had a high prevalence of suicidality, post-traumatic stress disorder, substance abuse, generalized anxiety and major depressive disorder.

Protesters march to celebrate trans people who have died at the 13th annual International Transgender Day of Remembrance
Protesters march to celebrate trans people who have died at the 13th annual International Transgender Day of Remembrance

“The high prevalence of mental health and substance use outcomes among young transgender women is a serious public health problem and necessitates clinical consideration in primary care settings and gender related treatment,” Sari Reisner, a co-author of the study, told BMJ.

The study included data from nearly three-hundred transgender women ages sixteen to twenty-nine who were enrolled in a pre-existing HIV intervention trial. The women, on average, were also poorer and less socially advantaged than the general population. Three out of every four were unemployed, and almost 50% reported making less than ten-thousand dollars a year.

Of the nearly 300 participants who identified as transgender women, over 40% had more than one mental health or substance abuse diagnosis and 20% had two or more such diagnoses.

The researchers found the prevalences for various diagnoses were as follows: “lifetime and current major depressive episode were 35.4%and 14.7%, respectively; past 30-day suicidality was 20.2%; past 6-month generalized anxiety disorder and posttraumatic stress disorder were 7.9% and 9.8%, respectively; and past 12-month alcohol dependence and nonalcohol psychoactive substance use were 11.2% and 15.2%, respectively.”

These estimates are between 1.7 and 3.6 times greater than what is expected for the general population.

The researchers warn that the study is limited in its generalizability as the participants who signed up for the HIV prevention study were selected based on the criteria that they engaged in sexually risky behavior.

“Interventions are urgently needed to address adverse mental health and substance use outcomes for young transgender women, including those delivered by health care professionals and via multidisciplinary teams in clinical community-based, pediatric, adolescent, and young adult medicine settings,” the researchers concluded.



Reisner S, Biello K, White Hughto J, et al. Psychiatric diagnoses and comorbidities in a diverse multicity cohort of young transgender women: baseline findings from Project LifeSkills. JAMA Pediatr 2016 (Abstract)

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Justin Karter
MIA Research News Editor: Justin M. Karter is the lead research news editor for Mad in America. He completed his doctorate in Counseling Psychology at the University of Massachusetts Boston. He also holds graduate degrees in both Journalism and Community Psychology from Point Park University. He brings a particular interest in examining and decoding cultural narratives of mental health and reimagining the institutions built on these assumptions.


    • Thanks. Yep, this is what was meant. When I came across the study, it reminded me of Jonathan Metzl’s book “The Protest Psychosis: How Schizophrenia Became a Black Disease.” Whenever a marginalized group begins to fight for civil rights we tend to see a massive increase in their pathologization.

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      • There are many instances of mental illness diagnosis being used to undermine the credibility of social and political adversaries throughout history. What a convenient and highly effective weapon to use against any opponent. Given the right social climate, such an accusation is all but impossible to get rid of. To judge its effectiveness, all one has to do is to look at the repeated use of it by the immensely powerful conservative right and the fates of their many targets: all people of color, and the gay and transgender communities.

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  1. While all or most of what was stated in the article may be accurate, the sources of the problems faced by transgender women was conspicuously absent. It was almost as though the author intended for the reader to be given the impression that trans women are mentally ill because they are transgender. Not so.

    Absent from this article is any mention of the facts that society as a whole is responsible for the state of transgender women’s mental health due entirely to their rejection of the truth that transgender people are born as they are and that they never had any choice in the manner in which they present themselves to the rest of the world.

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    • I agree 100%. I also found the absence of analysis of prior-life trauma to be conspicuously absent. It seems a likely hypothesis that transgenered females, fitting into two “othered” categories at once, would be more likely to be victimized in various ways by both their family members and the society at large. Ignoring this makes the research pretty meaningless, and leads to the expected, “Those poor women, they need mental health treatment to assist with their suffering!” rather than looking at why suffering might be greater in this particular population. I suppose that would require the uncomfortable admission that oppression, violence and abuse are actually quite common, an admission that would also tend to undermine the mental health system’s bottom line, and hence an admission that is not likely forthcoming in the near future.

      —- Steve

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  2. Can someone please inform me what’s causing all the transgender population? My grand daughter is transgender and I know her mother (my daughter) was heavily psychiatrically drugged at the time. Is the use of pyshotropics during pregnancy causing this or is due to the epidemic use of vaccines? In my opinion – use of both are out of control, but during the 70’s and 80’s this was not prevalent at all. I’m just trying to understand what’s changing the genes in the fetus?

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    • What’s causing it is that people are FINALLY no longer being overwhelmingly forced by family/state/police violence into living a lie, into spending their lives closeted and alone, into hiding under the mandate of “pass or die.”

      What’s causing it is that people are finally getting free, getting together, and getting active, to make space for the next generation to live authentic lives, so that they no longer have to live in hiding and fear, as their many, MANY elders and earlier counterparts did.

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    • I too want to know the how and why of transgender identity. I want to know why I am trans. There is no clear answer yet as to why there are transgender people. The one thing that is known is that transgender people have been a part of history for many thousands of years, perhaps even as far back as the very beginnings of people. While it is possible that changes brought about by medical intervention through prescription drugs may have something to do with some appearances of trans folk, not all of us are a result of such actions.

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  3. I would assume naturally that rejecting one’s body would get one off to a bad start in life. What kinds of homes do these people come from? Without lots of details it is hard to know why someone would deny their biological sex? Personally I think attacking one’s body has a deeper root than what we are being told. There is a subterranean element being kept secret.

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    • People are not necessarily defined by their physical sexual characteristics. Gender identity is said to be a function of the hypothalamus. While sex hormones are produced in the genitals that ultimately shape the body, gender identity was established in the brain long before such shaping takes place.

      The greater damage to the individual comes not from a denial of apparent physical sexual characteristics, but from the mismatch of those characteristics with the true gender of the person. Once a transgender person reaches puberty and hormones begin to misshape them, that is when the real damage begins. Damage is compounded by people that try to force the transgender individual to conform to the artificial construct of social gender roles.

      There is no secret being kept. What there is is an institutionalized denial of transgender identity by society today entirely for the sake of personal comfort. There was a time in history when transgender people were accorded respect and given an honored place the social structure. It was not until the spread of modern Christianity that views of transgender people began to change.

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      • Finally, someone who knows the history of human society. Thank you for sharing this wealth of information since this is an area that so many people are totally clueless about. The world was quite different before the advent of the early Church. It was very repressive in it’s first four to five hundred years, repression that we’re still paying the price for today. The early Church developed a true hatred and distrust of women in general so it’s no wonder that transgender people took a real hit when the Church established itself.

        For instance, one of the early Church Fathers, men who were responsible for the development of the Church’s theology and doctrine, wrote that men are only sinful in their bodies from the waist down while women were sinful in the entirety of their bodies. One Church father said that women were born over the sewers. There are even worse sayings from other Church Fathers but we don’t need to rehash them all out here. Suffice it to say that the Church has always put men on a pedestal and too bad for everyone else.

        Although Christianity presents itself as the religion of love, the early Church did many things that were destructive to the fabric of society in general. It introduced many prejudices that have hung on unto this present day.

        I am not Church bashing, just stating what anyone can read in its own history. Of course, this history as been repressed and hidden.

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        • Exactly. It’s like the history of the treatment of girls in Ireland by the church when they still held secular power in the nations government. The church ran Magdaline Laundries, named after Mary Magdaline who was a temple prostitute and believed by some to have been the wife of Yeshua ben Miriam other wise known as Jesus.

          There are many aspects of church history that the church would like very much to have vanish without a trace. The mention of transgender people by Jesus in the New Testament as eunuchs is just another point of irritation that I have not had the chance to discuss with anyone.

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          • Isn’t it interesting that young Irish women who became pregnant out of wedlock got sent to the Magdaline Laundries while the men who impregnated them got off totally free of any punishment or responsibility.

            You know your history. It’s good to have you here on MIA.

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          • And, most people don’t realize that the Holy Grail is probably Mary of Magdala herself, carrying the child of Jesus. There were repressive things against women already started in the early Church and it’s thought that for her own protection, and the protection of her unborn child, she was sent to what is now France. Mary didn’t fit the story line that Paul and men of his type laid down for the Church to follow.

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    • You know what’s an attack on my body? Gender assignment at birth. You know what gets people off to a bad start in life? GENDER ASSIGNMENT AT BIRTH. You know what’s disgusting and unnatural? Color-coding your infant children so that strangers know what their genitals look like. You know what trans people don’t need? YOUR ASSUMPTIONS.

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      • I find the format of this blog a bit confusing. Are you addressing me? If you are, I have no idea why you would be doing so with such an aggressive tone. I am a transgender woman. I was born in the 1950’s and thus gender assigned male at birth against my will and had that false gender identity enforced on me on penalty of psychiatric institutional confinement and torture.

        As a matter of fact I WAS tortured as a child for having made the mistake of revealing my “deviance” to a doctor in 1963.

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          • Thats alright. I was just confused and I get confused easily enough these days.

            Back before there was much in the way of public exposure or acceptance for gay and transgender people, it was not uncommon for one of us to be ‘institutionalized for our own good’ if we made the mistake of outing ourselves to the wrong person.

            I outed myself to a doctor when I was 9 years old. I spent time in a very frightening “hospital” in a room with no furniture and only one small window in the door.

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        • For the record I reported my own first comment and asked mods to remove it – because there’s no “edit” feature here – even though it was directed at Agni, I realize it’s not constructive.

          Chutney: I’m really glad you’re here, I think stories like yours are really vital to both the psych survivor / mad movement and lgbt movements, for people to remember the nature of the beasts/institutions we’re dealing with here.

          I’m a female-assigned person, pretty dysphoric about the whole thing, but I’m in my 20s so there’s been some degree of open lgbt culture around me since I was born…

          I’m reminded of Leslie Feinberg writing about their “after the revolution” dream of living in a hut by the sea where nobody would bother them, and going into town to tell people how the “old country” was, both of the beauty and courage they lived with, and how dark it was so people would know why they could never let powers like that take over again.

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          • Dysphoria is tough, almost impossible to deal with, especially if there was nobody around to help you understand what exactly is going on. My roommate is also a female assigned 20 something dealing with the effects of dysphoria in his life. I was lucky to have made friends with him when I had gone back to college. He was one of three people who helped me face my own gender dysphoria and come out at 54 years old.

            I did everything I could to bury myself behind the most elaborate collection of man masks I could construct. Yet, those masks always proved to be very fragile. It seemed that the masks would evaporate at the slightest touch. All the while, the screaming from deep inside kept getting louder and more powerful.

            Like the hut by the sea, I tried to build a studio by the sea where I could hide in the clothes of the mask of another self.

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