An Overview of Mental Health in Trans Youth for Clinicians

gender affirming healthcare gender affirming medical care pediatric gender affirming care transgender transgender continuing education online transgender health transgender health education online Nov 14, 2022

The Trevor Project completed their 2022 National Survey on LGBTQ Youth Mental Health publishing these findings:

  • Fewer than 1 in 3 transgender and nonbinary youth found their home to be gender-affirming.
  • 93% of transgender and nonbinary youth said that they have worried about transgender people being denied access to gender-affirming medical care due to state or local laws.
  • 71% of transgender and nonbinary youth reported that they have experienced discrimination based on their gender identity.


A 2015 study showed that compared with non-transgender peers, transgender youth were found to have an elevated risk of being diagnosed with depression (50.6% vs. 20.6%); suffer from anxiety (26.7% vs. 10%); had attempted suicide (17.2% vs. 6.1%); and had engaged in self-harming activities without lethal intent (16.7% vs. 4.4%).


As more recent studies have shown rates of despression, anxiety, and suicidal ideation more similar to their cis peers when trans and gender diverse youth experience affirming homes, social transition (2018 review article), and medical transition (2020 review article of the literature on medical transition) as desired by the youth, the current leading theory on these higher rates of mental health conditions relates to minority stress theory.


I found the article, Gender Affirming Care is Not Experimental Part II written by Brynn Tannehill, Dr. AJ Eckert, and Dr. David Gorski to be a really useful review and resource for the existent literature. Also included here is a highlights list:

  • Tordoff, D. M., Wanta, J. W., Collin, A., Stephney, C., Inwards-Breland, D. J., Ahrens, K. (2022) Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Network Open, 5(2), e220978.
  • Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation [published correction appears in Pediatrics. 2021 Apr;147(4):]. Pediatrics. 2020;145(2):e20191725. doi:10.1542/peds.2019-1725
  • Green, A. E., DeChants, J. P., Price, M. N., & Davis, C. K. (2021). Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. Journal of Adolescent Health.
  • de Lara, D. L., Rodríguez, O. P., Flores, I. C., Masa, J. L. P., Campos-Muñoz, L., Hernández, M. C., & Amador, J. T. R. (2020). Psychosocial assessment in transgender adolescents. Anales de Pediatría (English Edition), 93(1), 41-48.
  • Kaltiala, R., Heino, E., Työläjärvi, M., & Suomalainen, L. (2020). Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria. Nordic Journal of Psychiatry, 74(3), 213-219.
  • Achille, C., Taggart, T., Eaton, N. R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T. A. (2020). Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results. International Journal of Pediatric Endocrinology, 2020(1), 1-5.
  • Hodax JK, Wagner J, Sackett-Taylor AC, Rafferty J, Forcier M. Medical Options for Care of Gender Diverse and Transgender Youth. J Pediatr Adolesc Gynecol. 2020 Feb;33(1):3-9. doi: 10.1016/j.jpag.2019.05.010. Epub 2019 May 30. PMID: 31154017.
  • Kuper, L. , L. E., Stewart, S., Preston, S., Lau, M., & Lopez, X. (2020). Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics, 145(4).
  • Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Well-being and suicidality among transgender youth after gender-affirming hormones. Clinical Practice in Pediatric Psychology, 7(3), 302.
  • Kimberly LL, Folkers KM, Friesen P, Sultan D, Quinn GP, Bateman-House A, Parent B, Konnoth C, Janssen A, Shah LD, Bluebond-Langner R, Salas-Humara C. Ethical Issues in Gender-Affirming Care for Youth. Pediatrics. 2018 Dec;142(6):e20181537. doi: 10.1542/peds.2018-1537. Epub 2018 Nov 6. PMID: 30401789.
  • Wiepjes CM, Nota NM, de Blok CJM, et al.  The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): trends in prevalence, treatment, and regrets. J Sex Med. 2018;15(4):582-590.
  • Simone Mahfouda, Julia K Moore, Aris Siafarikas, Florian D Zepf, Ashleigh Lin, Puberty suppression in transgender children and adolescents, The Lancet Diabetes & Endocrinology, Volume 5, Issue 10, 2017, Pages 816-826, ISSN 2213-8587,
  • De Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696-704.
  • de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011 Aug;8(8):2276-83. doi: 10.1111/j.1743-6109.2010.01943.x. Epub 2010 Jul 14. PMID: 20646177


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