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Transgender people are individuals whose gender identity does not match their gender assigned at birth. A 2016 study from The Williams Institute at UCLA estimated that there are 1.4 million transgender people in the U.S.
Unfortunately, transgender people suffer dramatically elevated rates of anxiety, depression, PTSD, and substance use disorders when compared with their cisgender peers. These mental health disparities are thought to be due to a range of factors including lack of access to gender-affirming care, societal stigma, high rates of physical and sexual victimization, and discriminatory public policies.
In 2018, The United Nations recommended that nations create streamlined pathways for transgender people to change their government-issued identification documents to match their gender identity. Unfortunately, most nations, including the United States, have not lived up to this mandate.
A new study in Lancet Public Health examined how this failure may be impacting the mental health of transgender people in the U.S. The research team used data from the 2015 US Transgender Survey, the largest survey of transgender people in existence, with over 27,000 participants.
The team, lead by Dr. Aydem Scheim from Drexel University, found that only 10.7% of participants in the study had their asserted name and gender marker on all of their government IDs. 45.1% of the sample had their asserted name and gender on none of their government IDs.
Those who had access to gender-congruent government IDs had a lower odds of severe psychological distress and a lower odds of considering suicide or planning how they would go about it.
The authors highlight a range of ways through which gender-congruent IDs may influence mental health. Lack of gender-congruent identification may increase one's risk of experiencing discrimination and violence in non-affirming environments. Using an ID that does not match one's gender identity may also lead to psychological dissonance and distress, along with a feeling of non-acceptance by one's nation and community. Having an incongruent ID may also lead people to avoid or be unable to access health care, employment, and social services.
It is important to note that the study has some limitations, including its cross-sectional study design, which makes causal interpretation difficult. It is possible, for example, that those with better mental health may be better able to navigate the difficult bureaucratic requirements to obtain gender-congruent IDs. Even if this reverse causation were true, the study highlights the need to increase the availability of and streamline the processes to obtain gender congruent IDs.
In an accompanying editorial, Dr. Monica Malta and colleagues, including myself, point out that even among those whose IDs are all gender-congruent, there was still a high rate of considering suicide (30%). This highlights the fact that although gender-congruent identification is vital for improving the mental health of transgender people in the U.S., there are a range of other determinants of mental health we need to work on, including the low level of family support for transgender people's gender identity, exposure to gender identity conversion efforts, high rates of poverty, unstable housing, and inadequate access to gender-affirming care, to name a few.
The study comes amidst a flurry of newly proposed state bills that would likely discriminate against transgender people in the U.S. For example, the Idaho legislature passed a bill today that would ban transgender students from playing on sports teams that match their identity. Legislators in several U.S. states have introduced separate legislation that would make gender-affirming medical care for adolescents (recommended by The American Academy of Pediatrics, The American Medical Association, The American Academy of Child & Adolescent Psychiatry, and The Endocrine Society) illegal. Doctors and other experts around the country have been speaking out against these bills.
