Transgender Mental Health

Transgender people are exploding into mass consciousness like never before, with celebrities like Laverne Cox and Caitlyn Jenner gracing the cover of popular magazines, and parents of gender nonconforming children standing up for fair treatment in schools across the country. At the same time, future psychiatrists are completing medical school and residency with, in most cases, little to no training on the physical and mental health disparities faced by transgender people.

This issue of Psychiatric Annals introduces the basic concepts necessary to provide adequate health care services to transgender patients. Dr. Hilary Maia Grubb begins with an article titled “Marginalization of Transgender Identities: Implications for Health Equity,” which covers terminology, access to care, discrimination, and providers' assumptions. Dr. Grubb calls for psychiatrists to practice cultural humility and to advocate for equity in health care practices.

In his article, Dr. Jack Pula takes on “The Role of the Psychiatrist Working with Transgender Patients,” and discusses initial evaluations, models for obtaining transition-related medical care (ie, informed consent), working with clients through social, medical, and surgical transition, and writing surgical referral letters.

In the article “Mental Health and the Transgender Population,” we review the effects of discrimination and violence on mental health, using the Minority Stress Model. Like other marginalized groups, transgender people learn to cope, productively and/or maladaptively, in difficult circumstances. Many face intersecting oppressions related to race and socioeconomics. The result is increased rates of anxiety, depression, suicidal tendencies, and substance abuse. Treatment by affirming providers can be lifesaving, and resilience building can happen both in and outside of the office.

There could not be a discussion of transgender mental health without an explanation of the history of and controversy over gender-related diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)¹ and the International Classification of Diseases and Related Health Problems, 10th edition (ICD-10).² In the article “Gender Diagnoses in the DSM and ICD,” Dr. Jack Drescher, who served on the DSM-5 Workgroup on Sexual and Gender Identity Disorders, outlines the gender-related diagnoses included in each manual. He urges psychiatrists to consider the history and legacy of pathologizing identity.

In the last article, child psychiatrist Dr. Nathaniel Sharon provides an introduction to treating transgender and gender nonconforming youth in “Psychiatry's Role in Supporting Healthy Development in Gender Diverse Children.” He discusses epidemiology, developmental outcomes, assessment, competent and gender-affirming care, and social and medical interventions. He warns against the damaging effects of conversion therapy on mental health.

It is our hope that the experts and clinicians who have contributed to this issue will encourage psychiatrists to learn more about transgender communities, and to offer affirming health services to every patient regardless of gender identity.