Category: Mental health
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Trans-identified people have higher than average rates of all mental illnesses.
A study1 of the medical records of 10,270 trans-identified patients found that 58% had at least one psychiatric diagnosis. This compares to just 13.6% of patients without trans identities. Trans-identified patients showed greater prevalence of every psychiatric condition queried, with major depressive disorder and generalized anxiety disorder being the most common diagnoses (31% and 12%, respectively). There was also an increased lifetime prevalence of bipolar disorder (11%) and psychotic disorders (4.7% overall, 2.5% for schizophrenia and 2.2% for schizoaffective disorder) in trans-identified patients.
- Wanta JW, Niforatos JD, Durbak E, Viguera A, Altinay M. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgender Health. 2019 Nov 1;4(1):313-315. doi: 10.1089/trgh.2019.0029. PMID: 31701012; PMCID: PMC6830528. ↩︎
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Psychological effects of puberty blockers on young people may be worse than placebo.
An analysis1 comparing psychological effects of puberty blockers on teenagers with gender dysphoria with existing research on placebo effects for various mental health conditions found that placebo effects appeared to be at least as strong as the effect of puberty blockers, if not stronger.
- https://sex-matters.org/wp-content/uploads/2022/12/Teenagers-medication-vs-placebo.pdf ↩︎
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Depression symptoms got worse in children taking puberty blockers.
In a study1 of 94 children with gender dysphoria, aged 8-16 and beginning to take puberty blockers, depression symptoms were more likely to get worse than to improve over two years of treatment. Scores on the Beck Depression Inventory (BDI-Y) went from 72% average, 10% mildly elevated, 10% moderately elevated, and 8% severely elevated at baseline to 75% average, 7% mildly elevated, 14% moderately elevated, and 9% severely elevated after 24 months.
This study was conducted from 2016 to 2021 by Dr. Johanna Olson-Kennedy. In 2024, the New York Times reported2 Dr. Olson-Kennedy saying that publication of this research had been delayed because she feared that research showing that puberty blockers did not improve patients’ mental health would be “weaponized” against the use of puberty blockers by opponents of the practice. The report appeared as a pre-print, not peer-reviewed, in May 2025.
- Johanna Olson-Kennedy, Liyuan Wang, Carolyn F. Wong, Diane Chen, Diane Ehrensaft, Marco A. Hidalgo, Amy C. Tishelman, Yee-Ming Chan, Robert Garofalo, Asa E. Radix, Stephen M. Rosenthal, Emotional Health of Transgender Youth 24 Months After Initiating Gender-Affirming Hormone Therapy, Journal of Adolescent Health, Volume 77, Issue 1, 2025, Pages 41-50, ISSN 1054-139X, https://doi.org/10.1016/j.jadohealth.2024.11.014. ↩︎
- https://www.nytimes.com/2024/10/23/science/puberty-blockers-olson-kennedy.html
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More patients on puberty blockers saw their distress deteriorate than improve.
A study1 of children from 12-15 receiving puberty blockers via the Gender Identity and Development Service showed that 37-70% of patients showed no improvement in levels of distress. 15-34% showed deterioration, while only 9-29% showed improvement.
The highest rate of deterioration (34%) was recorded at the 12 month evaluation, when the sample size was at its largest. Evaluations at 24 and 36 months were affected by significant loss to follow-up, which compromises the data.
- McPherson, S., & Freedman, D. E. P. (2023). Psychological Outcomes of 12–15-Year-Olds with Gender Dysphoria Receiving Pubertal Suppression in the UK: Assessing Reliable and Clinically Significant Change. Journal of Sex & Marital Therapy, 50(3), 315–325. https://doi.org/10.1080/0092623X.2023.2281986 ↩︎
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Rates of suicidality and self-harm did not improve in teenagers taking puberty blockers.
In a prospective study1 of patients aged 12-15 referred to University College Hospital, London by the Gender Identity Development Service, patients on puberty blockers showed no change in rates of suicidality or self-harm.
This study is compromised by the lack of follow-up once patients reached the age of 16, meaning there were significant effective drop-out rates at 24 and 36 months.
- Carmichael P, Butler G, Masic U, Cole TJ, De Stavola BL, Davidson S, Skageberg EM, Khadr S, Viner RM. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS One. 2021 Feb 2;16(2):e0243894. doi: 10.1371/journal.pone.0243894. PMID: 33529227; PMCID: PMC7853497. ↩︎
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Teenagers taking puberty blockers report more negative mood changes over time.
In a prospective study1 of patients aged 12-15 referred to University College Hospital, London by the Gender Identity Development Service, patients reported increases in negative mood and decreases in positive mood over time since beginning puberty blockage.
This study is compromised by the lack of follow-up once patients reached the age of 16, meaning there were significant effective drop-out rates at 24 and 36 months.
- Carmichael P, Butler G, Masic U, Cole TJ, De Stavola BL, Davidson S, Skageberg EM, Khadr S, Viner RM. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS One. 2021 Feb 2;16(2):e0243894. doi: 10.1371/journal.pone.0243894. PMID: 33529227; PMCID: PMC7853497. ↩︎
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Puberty blockers did not improve psychological functioning of GIDS patients.
In a prospective study1 of patients aged 12-15 referred to University College Hospital, London by the Gender Identity Development Service, psychological functioning (measured using the Child Behaviour Checklist) was not shown to improve 12, 24 or 36 months after beginning puberty blockage.
This study is compromised by the lack of follow-up once patients reached the age of 16, meaning there were significant effective drop-out rates at 24 and 36 months.
- Carmichael P, Butler G, Masic U, Cole TJ, De Stavola BL, Davidson S, Skageberg EM, Khadr S, Viner RM. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS One. 2021 Feb 2;16(2):e0243894. doi: 10.1371/journal.pone.0243894. PMID: 33529227; PMCID: PMC7853497. ↩︎
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43% of trans-identified people experience anxiety. The figure is higher for females.
A systematic review1 of 71 studies, comprising 73,565 transgender individuals from 23 countries, found a global pooled prevalence of anxiety of 43%. Prevalence was 59% amongst “non-binary” people and 44% for “transmasculine” people.
- Oliveira Teles, D., Alves de Oliveira, R., de Mendonça Figueirêdo Coelho, M., Bezerra Pinheiro, A. K., & Lannes Fernandes, F. (2025). Worldwide prevalence of anxiety in transgender persons: Systematic review with meta-analysis. International Journal of Transgender Health, 1–23. https://doi.org/10.1080/26895269.2025.2498753 ↩︎
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More than 80% of trans-identified young people experienced depressive mood, and more than half had considered suicide.
In a national quantitative cross-sectional survey1 of more than 25,000 “LGBQ” people, aged between 13 and 24 years, in the U.S., 82% reported experiencing depressive mood. 54% said they had seriously considered suicide, and 28% reported attempting suicide, in the last 12 months. Across all groups, females were more likely to experience depression, suicidality and attempted suicide than males. Participants with “trans” and “non-binary” identities were about twice as likely to report depressive mood and having considered suicide, and about one and a half times as likely to report a suicide attempt.
- Price-Feeney, Myeshia et al., Understanding the Mental Health of Transgender and Nonbinary Youth, Journal of Adolescent Health, Volume 66, Issue 6, 684 – 690 ↩︎
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“Gender questioning” adolescents may have very high rates of disordered eating.
In a cross-sectional study1 of 660 Australian adolescents described as “trans,” “non-binary” and “gender questioning,” adolescents who reported feeling unsure about their “gender identity” had the highest rates of nearly all symptoms of anorexia and bulimia.
- Kerr JA, Paine J, Thrower E, Hoq M, Mollica C, Sawyer SM, Azzopardi PS, Pang KC. Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health. 2024 Apr;74(4):850-853. doi: 10.1016/j.jadohealth.2023.11.396. Epub 2024 Jan 9. PMID: 38206224.
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- Kerr JA, Paine J, Thrower E, Hoq M, Mollica C, Sawyer SM, Azzopardi PS, Pang KC. Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health. 2024 Apr;74(4):850-853. doi: 10.1016/j.jadohealth.2023.11.396. Epub 2024 Jan 9. PMID: 38206224.
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Nearly a quarter of adolescents seeking “gender-affirming care” report symptoms of anorexia.
In a cross-sectional study1 of 660 Australian adolescents described as “trans,” “non-binary” and “gender questioning,” 23.9% reported symptoms of anorexia. Prevalence of disordered eating was more common in female patients than in male, regardless of whether they identified as trans or non-binary.
- Kerr JA, Paine J, Thrower E, Hoq M, Mollica C, Sawyer SM, Azzopardi PS, Pang KC. Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health. 2024 Apr;74(4):850-853. doi: 10.1016/j.jadohealth.2023.11.396. Epub 2024 Jan 9. PMID: 38206224. ↩︎
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Young people with “trans” identities are much more likely to have an eating disorder.
A study1 of data concerning 289,024 students from 223 U.S. universities found that students with a “trans” identity were almost four times more likely to have a self-reported eating disorder (OR: 4.62, 95% CI: 3.41-6.26) than their straight female peers. They were also about twice as likely to report past month use of diet pills (OR: 2.05, 95% CI: 1.48-2.83) and vomiting or laxatives (OR: 2.46, 95% CI: 1.83-3.30).
- Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE. Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. Journal of Adolescent Health. 2015 Aug;57(2):144-9. doi: 10.1016/j.jadohealth.2015.03.003. Epub 2015 Apr 28. PMID: 25937471; PMCID: PMC4545276. ↩︎
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Up to half of trans-identified children show disordered eating.
In an analysis1 of research conducted in 2022-23, 20-50% of children expressing a “trans” identity reported engaging in some form of disordered eating. More than 30% screened positive for eating disorder symptoms, and up to 12% had received an eating disorder diagnosis.
- Keski-Rahkonen A. Eating disorders in transgender and gender diverse people: characteristics, assessment, and management. Current Opinion in Psychiatry. 2023 Nov 1;36(6):412-418. doi: 10.1097/YCO.0000000000000902. Epub 2023 Aug 29. PMID: 37781981.
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- Keski-Rahkonen A. Eating disorders in transgender and gender diverse people: characteristics, assessment, and management. Current Opinion in Psychiatry. 2023 Nov 1;36(6):412-418. doi: 10.1097/YCO.0000000000000902. Epub 2023 Aug 29. PMID: 37781981.
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Autistic children with gender dysphoria were also more likely to be dissatisfied with other parts of their bodies.
A cohort study of Australian children with trans identities1 found that children with autistic traits were more likely to express dissatisfaction with body parts unrelated to sex (e.g. nose, feet.) The study also found that frequency of voice dysphoria was higher in the autistic trait group.
- A comparison of gender diversity in transgender young people with and without autistic traits from the Trans 20 cohort study
Tollit, Michelle A. et al.
The Lancet Regional Health – Western Pacific, Volume 47, 101084
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- A comparison of gender diversity in transgender young people with and without autistic traits from the Trans 20 cohort study
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Quality Of Life scores start to decline around one year after “gender-affirming” surgery. After five years, these scores are below pre-surgery levels.
A systematic review and meta-analysis1 of studies on the Quality Of Life (QoL) of transgender patients showed that in every domain, these patients tended to have poor QoL compared to the general population. Some patients showed an increase in QoL in some domains, but this peaked after about a year. After five years, these scores were below pre-transition levels.
- Nobili, A., Glazebrook, C. & Arcelus, J. Quality of life of treatment-seeking transgender adults: A systematic review and meta-analysis. Rev Endocr Metab Disord 19, 199–220 (2018). https://doi.org/10.1007/s11154-018-9459-y ↩︎
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One study found adults diagnosed with gender incongruence were nearly four times more likely to receive antidepressants or anti-anxiety medications than the general population.
An analysis1 of the 2005−2015 Swedish Total Population and Prescribed Drug Registers examined 2,679 adults diagnosed with gender incongruence. Compared to the general population, these individuals were 3.95 times more likely to receive antidepressant prescriptions and 3.43 times more likely to receive anxiolytic (anti-anxiety) prescriptions. The study also found they were six times more likely to have mood or anxiety disorder healthcare visits and more than six times more likely to be hospitalised following suicide attempts.
- Bränström, R., & Pachankis, J. E. (2020). “Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study”: Correction. The American Journal of Psychiatry, 177(8), 734. https://doi.org/10.1176/appi.ajp.2019.19010080 ↩︎
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Trans-identified adolescents are prescribed psychotropic medications more than twice as often as their siblings, with rates increasing after medical transition.
A 2021 study in the Journal of Sexual Medicine1 found that trans-identified adolescents in the US military healthcare system were prescribed psychotropic medications (such as antidepressants, sleep aids, antipsychotics, and mood stabilizers) at more than double the rate of their siblings (IRR = 2.57), with prescriptions increasing after “gender-affirming pharmaceutical initiation” (IRR = 1.67). The study compared mental health diagnoses, service use, and medication patterns before and after this medical transition step.
- Hisle-Gorman, E., Schvey, N. A., Adirim, T. A., Rayne, A. K., Susi, A., Roberts, T. A., & Klein, D. A. (2021). Mental healthcare utilization of transgender youth before and after affirming treatment. The Journal of Sexual Medicine, 18(8), 1444-1454. [Link] ↩︎
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“Gender-affirming” surgery is associated with increased risk of depression, anxiety, suicidal ideation, and substance use disorders.
A 2025 U.S. national database study1 examined over 107,000 adults diagnosed with gender dysphoria to compare those who did and did not undergo “gender-affirming” surgery. Using matched cohorts controlling for age, race, and ethnicity, the study found significantly higher risks of depression, anxiety, suicidal ideation, and substance use disorders within two years after surgery.
For males who had surgery, depression was 25.4% vs. 11.5% without surgery (RR 2.20) and anxiety 12.8% vs. 2.6% (RR 4.88). Females also showed increased rates: depression 22.9% vs. 14.6% (RR 1.56) and anxiety 10.5% vs. 7.1% (RR 1.48). Those undergoing feminizing procedures had particularly elevated risk for depression (RR 1.78) and substance use disorders (RR 1.28).
- Lewis, J. E., Patterson, A. R., Effirim, M. A., Patel, M. M., Lim, S. E., Cuello, V. A., … & Lee, W. C. (2025). Examining gender-specific mental health risks after gender-affirming surgery: a national database study. The Journal of Sexual Medicine, 22(4), 645-651. [Link] ↩︎
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A Finnish study found detransitioners commonly had psychiatric comorbidities and childhood trauma, with most concluding their gender dysphoria arose from psychological distress rather than transgender identity.
A 2025 case series1 from Helsinki University Hospital reviewed nine adults who sought medical detransition after previously receiving “gender-affirming” treatments.
Seven were natal females and all expressed “major regret”; both natal males expressed “minor regret.” The average time from diagnosis to regret was 7 years. Patients had used hormones for an average of 7 years (median 4 years), with eight undergoing chest reconstruction/augmentation surgery and four females having reproductive organs surgically removed.
All nine had psychiatric comorbidities—mood disorders were most common (8 patients: 2 with bipolar II, 6 with depression), anxiety disorders (6 patients initially, 7 by detransition), personality disorders (3 patients, with borderline personality disorder increasing from 2 to 5 patients by detransition), and dissociative disorders (1 initially, 3 total). Childhood trauma was universal, with all having insecure attachment styles. Six reported sexual abuse/rape and six experienced school bullying. Eating disorders were diagnosed in 4 patients, with 78% having eating disorder symptoms.
Patients retrospectively believed their gender dysphoria stemmed from unresolved psychological stressors and developmental challenges rather than a stable transgender identity. The clinic has since revised its protocols to improve psychiatric screening, facilitate easier re-access for detransitioners without referrals, and emphasize clinical neutrality.
- Kettula, K., Puustinen, N., Tynkkynen, L., Lempinen, L., & Tuisku, K. (2025). Gender Dysphoria and Detransitioning in Adults: An Analysis of Nine Patients from a Gender Identity Clinic from Finland. Archives of Sexual Behavior, 54(5), 1981-1990. [Link] ↩︎
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Co-occurring mental health issues, rather than gender dysphoria, are the primary predictors of both all-cause and suicide-related mortality in adolescents seeking gender-related care
A 2024 study by Ruuska et al.1, which analyzed data from 2,083 adolescents referred to gender identity clinics and 16,643 matched controls, reported higher initial mortality rates among referred adolescents (0.81 per 1000 person-years) compared to controls (0.40 per 1000 person-years). The suicide rates were also higher among the referred group (0.51 per 1000 person-years versus 0.12 per 1000 person-years). However, after controlling for history of psychiatric treatment, these differences in mortality rates between the two groups were not statistically significant, with hazard ratios normalizing at 1.0 for all-cause mortality and 1.8 for suicide mortality.
- Ruuska, S. M., Tuisku, K., Holttinen, T., & Kaltiala, R. (2024). All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study. BMJ Ment Health, 27(1). [Link] ↩︎