Trans and non-binary mental health

Transphobia

You might experience negative attitudes and treatment for being trans or non-binary. This could be from people around you and wider society, including from LGBQIA+ people. Unfortunately, there is evidence that these negative attitudes are increasing in England and Wales.

These experiences could include:

• Negative media stories about trans and non-binary people. For example, they may suggest that trans and non-binary people are deceptive or threatening. Or that trans and non-binary people rush into decisions about their bodies. Being surrounded by these messages may make you feel worn down or unwelcome.
• Assumptions about you being male or female, if you're non-binary. This could make you feel invisible, and pressured to conform to society's expectations about gender.
• Denying your identity. This can be things like refusing to use your correct pronouns, such as she, they or he. Or not using your preferred name when speaking to you. This could make you feel unseen, not respected, and unsafe.
• Worries about expressing yourself in public. For example, you may change the way you dress if you're worried about how people may treat you. You might find your experience of transphobia changes depending on how other people perceive your gender.
• Problems with dating and relationships. For example, it might feel hard to find a partner who accepts and validates who you are. This might be due to people's fixed ideas about gender. These experiences could affect your self-esteem.
• Loneliness because of the negative attitudes you face about who you are. You may worry about building other relationships if you've been treated badly before.

Transphobia can also run deeper than any specific incident or person. It can feel like an everyday part of the world we live in.

Difficult experiences of coming out

Telling people you're trans or non-binary is something you'll likely do many times. You might find it liberating, allowing you to be yourself. It could also be very difficult and have painful consequences.

You may worry about facing discrimination if you tell people. Or if you already tried and it went badly, you might not feel safe doing it again.

Feeling unable to tell people about being trans or non-binary may affect your wellbeing. And it could contribute to mental health problems like depression and anxiety. 

Whether you decide to tell everybody, nobody or some people, nobody should make that choice apart from you.

Exclusion from LGBQIA+ spaces

You may experience negative attitudes from within LGBQIA+ communities, as well as outside of these communities. For example, people might not want trans or non-binary issues associated with LGBQIA+ issues.

Some LGBQIA+ people may have fixed views about gender, which might lead them to discriminate against trans and non-binary people.

I was facing some backlash from my chosen LGB family about coming out as trans. I felt very alone

Internalised transphobia

You may feel bad about your own identity because of negative attitudes around you. You might feel ashamed of your identity or not want other people to know you're trans.

If you're non-binary, having to navigate a binary society and services could make you feel like your gender isn't valid.

Experiencing these negative feelings can affect your mental health. For example, it may contribute to depression and anxiety, and affect your self-esteem.

Feelings about your gender

Being trans or non-binary isn't a mental health problem. But you may experience unease or distress if your assigned sex and gender identity don't match. This can impact your mental health.

You might feel distressed or uneasy about different things:

• Your body. For example if you feel that your shape, hair or genitals don't match your gender identity.
• People getting your gender wrong (misgendering you). For example, if you're a trans man but someone assumes you're a woman, and refers to you as 'she' or 'her'.
• Feeling like you don't fit in with people who identify as the same gender as you. For example, if you're a trans woman but don't feel like you fit in or are welcome in women's spaces.

These feelings are sometimes called gender incongruence or gender dysphoria. These terms have different meanings:

• Gender incongruence means the mismatch between the sex assigned to you at birth and your gender identity. This can mean you want to make some changes to help you live in your gender identity.
• Gender dysphoria means distress you might feel because of this mismatch.

You may hear these terms used interchangeably. But they are different. Not everyone who experiences gender incongruence will also experience gender dysphoria.

People have different views about whether gender dysphoria is a helpful term. You may find it useful to talk about feeling dysphoric to name your experiences and help others understand. Or you may find the term stigmatising because it's also used to refer to a diagnosis.

However you feel about this term, you deserve support for any distress you experience.

Needing a diagnosis to access treatment

You might wish to have surgery or hormones through the NHS to help you transition. But to access these treatments on the NHS, you'll need a diagnosis of gender dysphoria or gender incongruence.

People have different views about diagnosis. You might find it:

• A helpful way to name your experiences and feelings.
• Stigmatising, for example if it makes you feel like there's something wrong with your identity. This could affect your self-esteem.
• Irrelevant, if you don't feel the need for medical transition. For example, you may want to change your hair, name or clothes to align with your gender identity. But you may not feel a need to have surgery or take hormones.

You may also feel that you shouldn't need a diagnosis to access transition healthcare. You should be able to tell your doctor what you need and have them believe you.

I think it was important for me to understand that transitioning isn't a magic fix, it doesn't solve all your problems. Once I started my transition, I still had to make sure to look after myself by talking through worries and concerns I had, as well as trying to take care of my mental and physical health

Barriers to transition healthcare

People have different experiences of getting help to transition. Some have positive experiences that support their gender identity. Others face challenges, which can affect their mental health.

You can complain if you experience poor care. But this can sometimes feel difficult to do, particularly if you have poor mental health. Citizens Advice has more information about complaining about NHS services.

These are some challenges you might face.

Long waiting lists

Many people have to wait years to receive support from an NHS Gender Identity Clinic (GIC). Waiting for care can be very distressing. It could contribute to stress, depression, anxiety and suicidal feelings.

You may:

• Feel that you can't live fully or build relationships until you transition.
• Feel unseen, for example if you're misgendered while you wait for care.
• Feel unsafe, if you experience abuse and harassment because of how people perceive you before transition.
• Experience health problems because of the wait. For example, if you have to bind your chest for longer. Or if you feel you can't seek mental health support, in case it delays your transition.
• Worry that health professionals might mistake your desire to transition as a symptom of a mental health problem.
• Experience money worries, if the wait is so long that you seek private healthcare instead.

If you're struggling with this, you could contact Gendered Intelligence's support line. This service supports trans and non-binary people affected by gender care waiting lists.

Pressure to prove that you need care

NHS transition healthcare tends to be based on fixed ideas about gender. You may feel pressure to fit into these ideas to prove that you need the care you're seeking.

For example, you might seek top surgery to reconstruct your chest. But to prove that you need this, you may feel you need to emphasise masculine parts of your identity. Or you might want oestrogen prescriptions. This might make you feel pressure to emphasise feminine parts of your identity.

This can be very stressful if you're non-binary. You may feel excluded by transition health services, if they see gender as binary. And you may face pressure to show an identity different to your own, to get the care you need. You may also experience these difficulties if you try to access other health services.

You might feel disempowered or excluded if you have to prove that you need healthcare. And if health professionals make decisions about what's best for you.

Barriers if you have an existing health problem

You may face a longer wait for transition healthcare if you have a physical or mental health problem.

The NHS might not offer some treatments if you don't meet certain requirements in your health. This includes accessing some surgeries.

For example, you may not be able to access some treatments if you're above a certain weight. Or if you have problems with other parts of your health, such as diabetes.

If you're admitted to hospital for a mental health problem, this might disrupt your transition healthcare. For example, it might delay surgery.

These experiences could lead to feelings of distress, depression, anxiety and suicidal feelings.

A lack of information about your rights

Health professionals may have different knowledge of what care you're entitled to. For example, not all GPs are trained enough to support you while you wait to see a Gender Identity Clinic. This support could include temporary hormone prescriptions, called bridging prescriptions.

If you're struggling to access transition healthcare, see our useful contacts page to find organisations who can help.

Barriers to legal gender recognition

If you're trans or non-binary, you may want a gender recognition certificate to legally recognise your gender identity.

People have different views on whether they want a certificate. For example, you might feel that you don't need one because the Equality Act is already meant to protect trans people from discrimination.

Or you might feel that a certificate can have a positive impact on your mental health. You may feel validated and safer if your ID and other documents show your correct gender.

But the process of applying for a certificate can be difficult. It might make you feel:

• Excluded, if you're non-binary. This is because the UK does not legally recognise genders other than male or female.
• Stressed by the process and the amount of evidence you have to submit. This could be even harder if you struggle with filling in forms. You may also feel stressed by the need to prove your gender identity in a way that other people don't.
• Powerless or exposed. This could be because other people who you don't know are looking at your private information and making decisions about you.
• Stigmatised by having to have a diagnosis of gender dysphoria or gender incongruence to get a certificate. You may feel that this diagnosis is saying there's something wrong with your identity.
• Pressure to get a diagnosis even if you don't want to undergo medical transition. You may feel as if you're not 'trans enough' if you don't want things like surgery or hormones. Or if you don't experience gender dysphoria.

If you're struggling to access legal gender recognition or don't know where to start, Gender Construction Kit has some suggestions.

Discrimination

You may be treated unfairly because you're trans or non-binary.

Not everyone will have these negative experiences. Excellent services and organisations do exist. But in society as a whole, LGBTQIA+ people are treated unequally.

Discrimination could happen in many areas of life – this section explains some common examples.

The healthcare system

Trans and non-binary people may face unequal treatment from health services. This may include transition healthcare, but also with other types of healthcare.

Some health professionals may not know enough about trans and non-binary people's needs and experiences. Or they might assume your physical and mental health problems relate to being trans.

They may hold negative attitudes about trans and non-binary people. They might misgender you or ask inappropriate questions about your identity. And health services might not have a way to record non-binary identities.

This can make it harder to trust and feel comfortable in services. This could make you feel less able to seek help.

Hospital treatment if you're trans or non-binary

Sometimes, mental health problems are treated in hospital. If you're trans or non-binary, you may experience challenges with this.

Many mental health wards in the UK are single sex spaces. Current NHS guidance says that you should be allowed to stay in the ward that matches your gender identity.

But some groups want the update to the NHS Constitution to enforce decisions about wards based on 'biological sex'. NHS Trusts might have their own rules as well.

These discussions and rule changes can make it hard to know if you're being treated fairly. Rules about single-sex wards can also be more complicated if you're non-binary.

Some trans and non-binary people find it difficult to maintain their gender identity in mental health hospitals. This may include wearing binders, using make up or taking hormones. If you're on a waiting list for gender-related surgery, this might be delayed if you're in hospital for your mental health.

These experiences can be distressing. They could affect your ability to feel safe and recover while in hospital. NHS trusts should have guidelines on how to treat trans and non-binary patients. But it can be difficult to ask for these things when you're struggling with your mental health.

Gendered Intelligence's support line is dedicated to supporting people waiting for gender-affirming healthcare. You could call this support line if you want to talk to someone about any delays you've experienced while in hospital.

Workplaces

You may face negative attitudes from employers and colleagues.

You might not feel confident reporting transphobic bullying to your employer. And you may worry about being treated badly at work or in job interviews, because of who you are. So you might feel like you need to hide your identity. For example, avoiding wearing clothes that reflect your gender identity.

Impact of discrimination

Experiencing discrimination can increase your risk of poor mental health. This is especially if you face different types of discrimination. For example, discrimination to do with being trans or non-binary and your race.  See our page on intersectionality and LGBTQIA+ to find out more about different types of discrimination.

It can also help to know your legal rights. Discrimination in some settings is not lawful in the UK under the Equality Act 2010. For example, unfair treatment from employers or healthcare professionals. 

See our page on complaining about health and social care for information on how to challenge discrimination by healthcare professionals.

The lack of understanding meant that I could not get the support that would have been available to someone who was cisgender and heterosexual.

Abuse and hate crime

Abuse is when someone hurts you physically, sexually, emotionally or financially. It can also include making threats towards you or damaging your belongings. A hate crime is when this abuse happens because of who you are, such as being trans or non-binary.

You might experience abuse and hate online or in person. It could be from a stranger, or someone you know. These experiences could make you feel unsafe. They can also impact your mental health – such as causing anxiety, sleep problems, suicidal feelings or PTSD.

Other experiences of discrimination or transphobia might make it harder to tell people what happened. You might worry that it won't be taken seriously. Or you might not realise that what you've experienced was abuse or hate.

Abuse and hate crimes are illegal. You deserve to feel safe.

To find out more, visit the charity Galop's information about hate and abuse. Or call Galop's confidential helpline for support. 

Conversion 'therapy'

Conversion 'therapy' means any practice that tries to change or suppress your sexual orientation or gender identity. It is a form of abuse. It may happen even though there is nothing wrong with trans or non-binary. You do not need to be 'cured' or changed.

These practices can include:

• Formal sessions that present themselves as 'therapy'
• More subtle practices, such as family members or faith groups advising you how to avoid acting on your gender identity
• More extreme practices, such as physical and sexual violence or exorcisms

Conversion 'therapy' practices are unethical and harmful. Among other things, they can contribute to:

• Anger
• Anxiety
• Depression
• Low self-esteem
• Suicidal feelings

Mind is calling for an outright ban of conversion practices. The government has proposed a ban to end conversion 'therapy'. But this ban does not specifically cover non-binary people, or ace, aro, bi+ and intersex people.

In the UK, many major health organisations have also condemned this dangerous practice. And all major counselling and psychotherapy bodies have called for an end to it.

Published: May 2024

Next review planned: May 2027

References and bibliography available on request.

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