Transgender Mental Health Therapy: What to Expect and How To Prepare

Mental health challenges are universal. Even with the acknowledgement of privilege and access to care, transgender individuals still experience mental health challenges at a significantly higher rate than the general population. A recent study found that 41% of transgender people have attempted suicide, compared to a national average for all adults of about 5%. The reasons for these challenges are not always obvious or simple to understand, which can make it even more challenging to manage them.

Thankfully, there is help available. If you identify as transgender and are facing challenges related to your mental health, working directly with a therapist who understands your specific needs as a trans individual can be immensely beneficial. In this blog post we’ll go over some common struggles among transgender individuals and what you should expect in therapy if you’re a trans person looking for support during this time.

Lack of Visibility and Understanding

One place to start is with how we view mental health challenges in our society as a whole. Many mental health issues are commonly viewed as individualized, isolated problems that are somehow caused by a person’s inherent “weakness” or lack of “strength.” When we see mental health issues this way, it becomes much harder to see the connections between these issues and the realities of everyday life—such as discrimination, lack of support, and lack of access to resources. When we have almost no representation of our identities and experiences in society, it becomes almost impossible for people to have any understanding of what we go through. On top of the reality that we live in a society that often reacts negatively to the mere existence of trans people, there is a further lack of understanding about what it means to be transgender. This leads to feelings of isolation and hopelessness, which can compound mental health challenges significantly.

Confidence and Identity Issues

The very existence of, and need for, transgender-specific mental health support is a clear indicator of how challenging it can be to simply exist as a trans person. One of the most common issues trans individuals are dealing with is a lack of self-confidence and a negative feeling towards their own identity. Internalized transphobia and society’s negative attitudes towards trans people can negatively impact your relationship with your own identity. This can lead to feelings of worthlessness, sadness, and even shame, which can cause you to lose confidence in yourself. This can affect aspects of your life as basic as your ability to get out of bed in the morning or to keep up with your friends and family. When this is happening, it can be extremely helpful to work with a therapist who is familiar with trans mental health issues and can help you work through your feelings of shame and boost your confidence and self-worth.

Depression, Anxiety, and Trauma

Another common mental health issue affecting many transgender individuals is depression and anxiety. There are many reasons for this, but the most common may be the internalized stigma and shame that many trans people carry. The shame that comes from living in a society that rejects you and invalidates your very existence can be incredibly painful and isolating. This shame can lead to an inability to reach out for help or support. It can also lead to feelings of hopelessness, which can contribute to depression and anxiety. When this shame is internalized, it becomes a part of your very identity. This can lead to a sense that you are unworthy of help, love, and support, which can make it nearly impossible to reach out to others. Working with a mental health professional who understands the unique challenges of transgender mental health can be incredibly helpful when dealing with depression and anxiety.

Being Misgendered or Discriminated Against

Another big issue is the experience of being misgendered and discriminated against by society at large. This can happen in multiple ways: you may be misgendered regularly by family members, friends, and colleagues, be denied services or employment because of your gender identity, or even be the victim of physical violence. The experience of being invalidated, misunderstood, and dehumanized by other people can take a huge toll on your mental health. It can lead to feelings of isolation and sadness and can negatively impact your self-worth. It can also lead to increased anxiety and stress due to the constant reminder that there are people in the world who expect you to be someone you are not. It can be incredibly helpful to work with a mental health professional who can help you process and make sense of these feelings.

Bisexuality and Visibility Issues

Another issue many trans individuals are dealing with is bisexuality-related stigma and shame. Although the bisexual community is making progress in terms of recognition and support, there are still many harmful stereotypes and stigmas attached to being bisexual. This can lead to feelings of shame and isolation as a bisexual individual. Working with a therapist who understands the bisexual experience can be very helpful in this situation.

Gender Confusion and Cognitive Dissonance

One of the most challenging mental health issues to understand is gender confusion and cognitive dissonance. This is the feeling that your gender identity and the gender you were assigned at birth don’t align, but you don’t know what the right path is or how to move forward. This feeling can come and go, but be incredibly painful when it’s present. Working with a therapist who knows how to support trans individuals in this difficult place is key.

Binge Eating as a Coping Mechanism

Binge eating is one of the most common ways that trans individuals cope with mental health challenges. It’s important to note that this can happen to anyone, but it is an issue that is seen very frequently in the transgender community. When you are dealing with a lot of emotional stress, it can be very difficult to know how to cope. Binge eating is a common way for people to deal with pain, but it comes with many risks. It can lead to many negative health outcomes and can be a sign of an eating disorder. Working with a therapist who understands transgender mental health issues can be helpful in this situation. They can help you learn healthier ways to cope and avoid the dangers of binge eating.

Transitioning and Self-Care Practices for Trans Mental Health

Transitioning can be incredibly helpful for many individuals who feel that their gender and bodies don’t align. Working with a therapist who understands the process and can help you navigate it in a healthy way can be good support during this time. Transitioning is a very individual process, so there is no “right” or “wrong” way to do it. There are, however, some general guidelines that can be helpful, like making sure you have a strong support system or being clear on your self-care practices. If you’re transitioning, it’s important to make sure you are checking in with yourself and maintaining consistent self-care practices. This can include things like eating a healthy diet, getting enough sleep, and obtaining regular exercise.


There is no one way to be transgender, and mental health struggles may take many forms. However, the good news is that help is available. Transgender individuals can and do seek treatment. Having a mental health professional who understands the unique needs of the trans community can be incredibly helpful during this process.

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