This article discusses mental health crises, including mentions of suicide. If you or someone you know is experiencing a mental health crisis, help is available. Call 911, go to the nearest emergency room, or call or text 988 to reach a trained crisis counselor at the Suicide & Crisis Lifeline. You can also reach out to trans-friendly mental health services or crisis hotlines such as the Trans Lifeline (877-565-8860) or the Trevor Project.
This article features Edith Moran, LCSW, a transgender therapist with Grow Therapy who works with the LGBT community through sexuality- and gender-affirming treatment
In a world where transgender identities are increasingly dismissed and threatened, and the safety of transgender people is at risk, there is power in visibility. Stepping into the light of recognition can be liberating. But as the daily reality for transgender people grows heavier, advocating for that visibility can feel daunting, if not dangerous.
In this post, we’ll explore the complexities of celebrating an international transgender day of visibility, the ways it uplifts yet challenges, and the intersection of the transgender experience and mental health. We’ll dive into the role therapy can plan in navigating identity, the importance of affirming support, and actionable steps trans people and allies can each take to co-create a world where visibility leads to connection, freedom, and authenticity.
Key terms used in this article
- Transgender – Someone whose gender identity or expression does not align with the sex assigned to them at birth.
- Body dysmorphia – When someone has a distorted view of their body, and experiences deep distress and preoccupation with their appearance.
- Gender dysphoria – Gender dysphoria can refer to an uneasy feeling of something being “not right” when someone’s gender identity — the way they feel inside — does not line up with the sex they were assigned at birth. It can also refer to the emotional distress stemming from society’s expectations based on a person’s assigned sex, and how those expectations come into conflict with how a transgender person identifies, acts, or presents.
- Cisgender – Someone whose gender identity and expression aligns with the sex they were assigned at birth.
- Gender-nonconforming/Gender-expansive – Someone whose identity or gender expression does not match society’s expectations for the sex they were assigned at birth.
- Nonbinary – Someone whose gender identity does not fall into one of two gender categories (man or woman).
- Misgender – To refer to someone using a word, especially a pronoun, that does not reflect their gender identity.
- Deadname (noun) – The name a transgender or nonbinary person was given at birth, but has chosen to no longer use.
- Deadname (verb) – To use a trans person’s birth name despite them having changed names as part of their transition.
- Internalized transnegativity – Also referred to as “internalized transphobia,” this refers to negative or uncomfortable feelings a trans person may feel as a result of internalizing society’s transphobia and/or expectations around gender.
Understanding Transgender Day of Visibility (TDOV)
Transgender Day of Visibility (TDOV) is celebrated annually on March 31st. It was founded in 2009 by American psychotherapist Rachel Crandall to advocate for transgender individuals and raise awareness of their challenges. As a transgender activist, Ms. Crandall created this movement in response to the media’s constant focus on violence in order to help shift the narrative toward celebrating trans people’s resilience, success, and everyday lives.
TDOV is different from Transgender Day of Remembrance (TDOR), which honors the lives that were lost due to anti-trans violence. TDOV brings into focus the lived experiences of trans individuals. Visibility is the foundation of this movement, as it helps break down stereotypes in the community, improves representations, and positively impacts the mental health of the transgender community.
Leaning into trans joy and community is what will get us through this trying, terrifying, and tumultuous time. Trans, nonbinary, and gender expansive folks need now, more than ever, social relationships, support from peers, and local, national, and global community.
- Edith Moran, LCSW, Grow Therapy Provider
While visibility plays an influential role in fostering acceptance, it also exposes transgender individuals to risks, including discrimination, harassment, and violence. With legislative attacks on trans rights and rollbacks in Diversity, Equity, and Inclusion (DEI) initiatives — such as banning transgender girls and women from sports, reducing access to or banning gender-affirming care, and identity-based rights restrictions — trans individuals face growing risks to their health, safety, and overall well-being.
Navigating personal safety with public recognition is a priority, as trans individuals work to stay safe while being seen, helping to ensure their well-being and foster acceptance in the broader community.
The mental health landscape for transgender people
The Trevor Project’s 2024 National Survey on LGBTQ Youth Mental Health reported that 65% of transgender and nonbinary youth have experienced discrimination based on their gender identity in the last year. In the 2022 US Trans Survey, 30% of respondents reported having been verbally harassed in the past year because of their gender identity and expression, and 44% reported having experienced serious psychological distress in the last 30 days.
Transgender and gender-nonconforming individuals are disproportionately affected by mental health disorders compared to cisgender people. These challenges include:
- It’s estimated that as many as 68% of US transgender adults experience anxiety, and 84% struggle with depression
- About 81% of transgender adults in the US have experienced suicidal ideation in their lifetime, and 42% have attempted suicide at least once
- Three in five transgender people report poor mental health at least one day per month (25% higher than cisgender respondents).
Transgender people face several mental health challenges related to discrimination and stigma, including family rejection, isolation, and discrimination, including within the healthcare system. Internal factors like internalized transnegativity (IT) and body dysmorphia can also contribute to distress.
The Trevor Project notes that transgender youth report body dissatisfaction and disordered eating behaviors related to gender dysphoria, which can contribute to internalized transnegativity by fostering a lack of pride in their trans identity, feelings of shame, and a sense of alienation from other trans individuals.
Barriers to mental health care
Research shows that gender-affirming care (puberty blockers, gender-affirming hormones, and gender affirming surgeries) are instrumental in alleviating symptoms associated with IT and of mental health concerns. However, the transgender community faces a growing set of barriers when seeking health care. This includes mental health support, a lack of which often compounds distress and conditions already taking place.
Common barriers to receiving mental health care include:
- Lack of culturally competent therapists. This could include provers who misgender, deadname, invalidate, or use non-inclusive interventions
- Financial barriers such as low income, or lack of insurance,
- Fear of discrimination in healthcare settings
- Socioeconomic barriers such as lacking transportation, internet for research, or housing for stability/recovery
These barriers are especially pronounced for trans youth, who are at a higher risk of homelessness due to stigma and discrimination.
Intersecting identities for transgender individuals
Transgender experiences are also shaped by factors outside of their gender identity, including race, immigration status, disability, and neurodivergence.
A 2022 study found that Black, indigenous, and people of color (BIPOC) trans individuals hold multiple marginalized identities. For example, they identify as a member of the LGBTQ+ community while also identifying as an Black person. Multiple, overlapping experiences of racism and transphobia can significantly worsen trans BIPOC experiences, compounding inequalities and leading to increased psychological distress.
Further, people with disabilities face higher rates of unmet healthcare needs, even with insurance, due to instances of ableism, transportation barriers, lack of knowledge, and discrimination.
Neurodivergent Insights notes that trans people are six times more likely to be diagnosed as autistic compared to cisgender adults, with many also reporting higher levels of autistic traits and sensory sensitivities.
This intersection presents unique challenges, as the risks of marginalization and oppression are amplified when autism and transgender identities overlap. In fact, 1 in 3 trans individuals has reported having their gender identity questioned simply because they are autistic. This experience can be incredibly invalidating, leading to feelings of frustration, isolation, and a lack of autonomy in their gender journey.
How therapy can support transgender mental health
Research notes community connectedness as the strongest protective factor for trans mental well-being. Other important protective factors for trans mental health include self-esteem, healthy relationships with family and peers, and LGBTQ-straight alliances within the community.
Having a safe, judgment-free space to question, explore, and think critically about one's gender, in my professional opinion, is of utmost importance not only to successful navigation of gender nonconformity, but also to being a well-balanced and fully realized individual.
- Edith Moran, LCSW, Grow Therapy Provider
Therapy is a powerful resource for transgender individuals to explore their identity, build self-worth, and cultivate resilience. Research notes community connectedness as the strongest protective factor for trans mental well-being, with other important protective factors for trans mental health include self-esteem, healthy relationships with family and peers, and LGBTQ-straight alliances within the community. A gender-affirming therapist can help trans individuals understand how to work these protective factors into their lives.
Edith Moran, LCSW, is a transgender therapist with Grow Therapy who works with the LGBT community through sexuality- and gender-affirming treatment. She notes that “Having a safe, judgment-free space to question, explore, and think critically about one’s gender, in my professional opinion, is of utmost importance not only to successful navigation of gender nonconformity, but also to being a well-balanced and fully realized individual.”
Creating space for gender exploration is a central purpose of affirming therapy, as it helps individuals navigate feelings of dysphoria while recognizing moments of gender euphoria (joy and affirmation in one’s true gender).
This balance is helpful, particularly in supporting trans people as they process the challenging emotions that arise from societal stigma and shame. Further, trans-inclusive therapeutic modalities and interventions can help address internalized transphobia, including the mental health repercussions such as anxiety and depression, and create a greater sense of alignment between identity, expression, and self-acceptance.
Among the various therapeutic approaches, some of the most effective that align with trans experiences include:
- Gender-affirming therapy: Supports individuals exploring and affirming their gender identity, specifically helping trans people navigate symptoms of gender dysphoria
- Transgender-affirmative cognitive behavior therapy (TA-CBT): Adapts CBT to provide a supportive approach to gender diversity and acknowledge the unique challenges and strengths of transgender individuals to improve symptoms of anxiety and depression
- Dialectical behavior therapy (DBT): Provides skills to help manage distressing emotions and navigating interpersonal relationship challenges, which is particularly effective in attending to those experiencing gender dysphoria
- Trauma-informed affirmative therapy: Incorporates an understanding of minority stress (e.g. victimization, rejection, and discrimination) and resilience in treatment approaches to reduce distress and promote healing
- Group therapy: A space to reduce distress, explore gender identity, and build resilience through the power of connection with those sharing similar experiences
These approaches support trans people, helping them deal with challenges and thrive.
The difference between affirmative therapy and conversion therapy
Affirmative therapy is a form of psychotherapy used to help validate and support those with minority identities, including trans individuals, helping to advocate for sexuality, gender expression, and self-empowerment.
Remember that gender-expansive people have always been here, are here now, and will continue to be here no matter what our leaders do, say, or legislate. We will get through this together.
- Edith Moran, LCSW, Grow Therapy Provider
Conversely, conversion therapy is a harmful practice that’s been discredited by reputable leading organizations. Multiple states have passed laws protecting LGBTQ+ youth from what’s widely considered to be a harmful practice. Conversion therapy attempts to change or suppress an individual’s gender identity. The goal of conversion therapy is to “convert someone back” to heterosexuality or cisgender identity. Conversion therapy reinforces distress, shame, and other mental health challenges.
People who practice conversion therapy may appear to be supportive at first. When considering or seeing a mental health provider who claims to be affirmative of your identity, be cautious of someone who:
- Dismisses or questions your identity
- Pushes gender norms or binary thinking
- Focuses on ‘fixing’ your gender identity
- Lack of knowledge or willingness to learn about transgender issues
- Minimizes or ignores intersectionality
- Neglects to consider or minimizes discrimination or trauma
Providers are likely to be trans-affirming when they demonstrate an outward respect for individual experience while creating a safe, nonjudgmental space for therapeutic exploration.
Hormones and mental health
Gender-affirming hormone therapy (GAHT), also known as hormone replacement therapy (HRT), has become a highly sought-after intervention for trans or nonbinary individuals seeking to align their outward characteristics with their gender identity.
Trans women use estrogen to promote feminizing changes, including reduced muscle mass and breast development, while trans men use testosterone to induce masculinizing changes, including a deeper voice and increased facial and body hair.
Unfortunately, access to hormone therapy is becoming more and more limited. At the time of this writing, there are 83 active bills in the US legislature that aim to restrict transgender healthcare. Even in states where gender-affirming care is available, individuals often face long wait times, restrictive eligibility criteria, and medical gatekeeping, which may lead to increased distress and heightened feelings of helplessness for those seeking care.
Coping with discrimination and microaggressions
Building resilience against transphobia and coping with discrimination and microaggressions can help trans individuals maintain their mental well-being. This involves developing strategies to address hurtful comments, subtle biases, or harmful behaviors in a way that protects their emotional and psychological health.
Strategies include:
- Setting clear and firm boundaries in social interactions
- Seeking support from trusted allies
- Developing a mental toolkit to challenge harmful beliefs (e.g. cognitive reframing or grounding techniques)
- Seeking therapy for ongoing support
While there is no excuse for the harmful actions or unkind words of others, having practices in place to foster emotional strength can be influential in creating a sense of empowerment over time.
Actionable ways to support trans mental health on TDOV and beyond
Community has been identified as a significant protective factor against mental health challenges for trans youths and adults alike. “Leaning into trans joy and community is what will get us through this trying, terrifying, and tumultuous time. Trans, nonbinary, and gender expansive folks need now, more than ever, social relationships, support from peers, and local, national, and global community,” says Moran.
It’s okay to not be okay. Give yourself and others grace. Be kind, lean into joy, and stand tall! The beauty of trans joy is that it is limitless, inspirational, and life-saving!
- Edith Moran, LCSW, Grow Therapy Provider
Some beneficial avenues to get support include:
- Online support groups: TrevorSpace and LGBTribe
- Community initiatives: Pride events and LGBTQ+ inclusive organizations
- Mental health resources: The Trevor Project and LGBT National Hotline
The allies in the trans community community can be an incredible support for the mental health of trans individuals. Being an ally involves those who actively listen, advocate for trans rights and inclusion, and who refrain from making assumptions about people’s genders in general.
For trans individuals
Some powerful ways that trans individuals can celebrate and lean into TDOV in ways that feel both safe and empowering include:
- Practicing self-care: Focusing on self-care practices to help support your journey, such as seeking moments of quiet reflections or practicing positive affirmations
- Engage in trans-focused events: Participate in activities or events in your community that can affirm your identity in a supportive environment
- Accessing crisis and mental health support: If needed, reach out to trans-friendly mental health services or crisis hotlines such as the Trans Lifeline (877-565-8860) or the Trevor Project
- Leaning on advocacy programs: Advocates for Trans Equality (A4TE) is a trans advocacy organization established to advance transgender rights by advocating for policy changes, providing legal support, and promoting equality and acceptance for trans people
Moran adds, “look for therapeutic and social groups at your local LGBTQ+ center or advocacy organization. Use social media to connect with others and build community. Be open and honest about your worries with those you trust. Ask for support, explicitly, from others and offer support in return. Most importantly, remember that gender-expansive people have always been here, are here now, and will continue to be here no matter what our leaders do, say, or legislate. We will get through this together.”
For allies and supporters
Support also extends outwards to the allies and supporters in the community. For those looking to become better allies for trans individuals, consider the following:
- Centering trans voices: Without taking up space ourselves, allies can actively listen and elevate trans perspectives to ensure their voices are heard and supported
- Being an active and affirming presence: Holding space, asking questions when appropriate, and providing support when needed without judgment can be instrumental in the trans community
- Donating to trans-led organizations: Giving back to organizations focused on the mental health and advocacy of trans individuals, such as The Trevor Project,, are powerful ways to support systemic change
Moran says, “The trans community is small but mighty! However, we need allies to help us achieve equality in society. We cannot do the work all on our own. Our cis siblings must stand with us and use thier voices, privilege, and power to help realize the dream of a more inclusive future feel possible.”
The power of visibility and care
Visibility is essential for progress, but it comes with real mental health challenges. Whether it’s therapy, community, or self-care, support is key to facing those challenges. For both trans individuals and allies, true progress requires consistent effort, learning, and ongoing activism to push for change.
Moran highlights, “It’s okay to not be okay. Give yourself and others grace. Be kind, lean into joy, and stand tall! The beauty of trans joy is that it is limitless, inspirational, and life-saving!”
For those ready to take the next step, we’re here to support you. Consider Grow Therapy to find a gender-affirming, compassionate therapist near you.