Depression and Gender Dysphoria

  • Eric N. BoyumEmail author
  • Peter Daniolos


Transgender youth, as a whole, are resilient and healthy young people, though a substantial minority will be at risk of depression and suicide. This chapter reviews three cases of transgender youth, describing their and their families’ journeys to come to terms with their gender identities, including periods of depression and self-injury. Existing literature is also reviewed to elaborate the nature, extent, and causes of depression among transgender individuals. The therapeutic approach to transgender youth presenting with depression or self-injury is discussed, along with the importance of family support and intervention. The process of determining whether to immediately refer depressed transgender youth for affirming medical interventions is also discussed.


Transgender youth LGBT youth Mental health Depression Suicide Self-injury 


  1. 1.
    de Vries ALC, Doreleijers TAH, Steensma TD, Cohen-Kettenis PT. Psychiatric comorbidity in gender dysphoric adolescents. J Child Psychol Psychiatry. 2011;52(11):1195–202.CrossRefPubMedGoogle Scholar
  2. 2.
    Mustanski BS, Garofalo R, Emerson EM. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. Am J Public Health. 2010;100(12):2426–32.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134(4):696–704.CrossRefPubMedGoogle Scholar
  4. 4.
    Dhejne C, Van Vlerken R, Heylens G, Arcelus J. Mental health and gender dysphoria: a review of the literature. Int Rev Psychiatry. 2016;28(1):44–57.CrossRefPubMedGoogle Scholar
  5. 5.
    Grossman AH, D'Augelli AR. Transgender youth and life-threatening behaviors. Suicide Life Threat Behav. 2007;37(5):527–37.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Arcelus J, Claes L, Witcomb GL, Marshall E, Bouman WP. Risk factors for non-suicidal self-injury among trans youth. J Sex Med. 2016;13(3):402–12.CrossRefPubMedGoogle Scholar
  7. 7.
    Olson J, Schrager SM, Belzer M, Simons LK, Clark LF. Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. J Adolesc Health. 2015;57(4):374–80.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Control NCfIPa. 10 Leading Causes of Death, United States: 2014, All Races, Both Sexes: United States Centers for Disease Control and Prevention; 2014 [updated December 8, 2015; cited Centers for Disease Control and Prevention].
  9. 9.
    Birmaher B, Brent D, Bernet W, Bukstein O, Walter H, Benson RS, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503–26.CrossRefPubMedGoogle Scholar
  10. 10.
    Spack NP, Edwards-Leeper L, Feldman HA, Leibowitz S, Mandel F, Diamond DA, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics. 2012;129(3):418–25.CrossRefPubMedGoogle Scholar
  11. 11.
    Zucker KJ. Gender identity disorder in children and adolescents. Ann Rev Clin Psychol. 2005;1:467–92.CrossRefGoogle Scholar
  12. 12.
    Yunger JL, Carver PR, Perry DG. Does gender identity influence children’s psychological well-being? Dev Psychol. 2004;40(4):572–82.CrossRefPubMedGoogle Scholar
  13. 13.
    Wallien MSC, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(10):1307–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Singh D, Bradley SJ, Zucker KJ. Commentary on “an affirmative intervention for families with gender variant children: parental ratings of child mental health and gender” by hill, Menvielle, Sica, and Johnson (2010). J Sex Marital Therapy. 2011;37(2):151–7.CrossRefGoogle Scholar
  15. 15.
    De Ceglie D, Freedman D, McPherson S, Richardson P. Children and adolescents referred to a specialist gender identity development service: clinical features and demographic characteristics: symposion; 2002.
  16. 16.
    Feinleib MR, editor. Report of the secretary’s task force on youth suicide. Rockville, MD: Alcohol Drug Abuse, and Mental Health Administration; 1989. p. 115.Google Scholar
  17. 17.
    Marshall E, Claes L, Bouman WP, Witcomb GL, Arcelus J. Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. Int Rev Psychiatry. 2016;28(1):58–69.CrossRefPubMedGoogle Scholar
  18. 18.
    Holt V, Skagerberg E, Dunsford M. Young people with features of gender dysphoria: demographics and associated difficulties. Clin Child Psychol Psychiatry. 2016;21(1):108–18.CrossRefPubMedGoogle Scholar
  19. 19.
    Skagerberg E, Parkinson R, Carmichael P. Self-harming thoughts and behaviors in a group of children and adolescents with gender dysphoria. Int J Transgender. 2013;14(2):86–92.CrossRefGoogle Scholar
  20. 20.
    Plener PL, Libal G, Keller F, Fegert JM, Muehlenkamp JJ. An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychol Med. 2009;39(9):1549–58.CrossRefPubMedGoogle Scholar
  21. 21.
    Aitken M, VanderLaan DP, Wasserman L, Stojanovski S, Zucker KJ. Self-harm and suicidality in children referred for gender dysphoria. J Am Acad Child Adolesc Psychiatry. 2016;55(6):513–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Reisner SL, Vetters R, Leclerc M, Zaslow S, Wolfrum S, Shumer D, et al. Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adolesc Health. 2015;56(3):274–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kosciw JG, Greytak EA, Palmer NA, Boesen MJ. The 2013 National School Climate Survey: the experiences of lesbian, gay, bisexual, and transgender youth in our nation's schools. New York City, NY: GLSEN; 2014.Google Scholar
  24. 24.
    Claes L, Bouman WP, Witcomb G, Thurston M, Fernandez-Aranda F, Arcelus J. Non-suicidal self-injury in trans people: associations with psychological symptoms, victimization, interpersonal functioning, and perceived social support. J Sex Med. 2015;12(1):168–79.CrossRefPubMedGoogle Scholar
  25. 25.
    Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex. 2006;51(3):53–69.CrossRefPubMedGoogle Scholar
  26. 26.
    Birkett M, Newcomb ME, Mustanski B. Does it get better? A longitudinal analysis of psychological distress and victimization in lesbian, gay, bisexual, transgender, and questioning youth. J Adolesc Health. 2015;56(3):280–5.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Roberts AL, Rosario M, Slopen N, Calzo JP, Austin SB. Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: an 11-year longitudinal study. J Am Acad Child Adolesc Psychiatry. 2013;52(2):143–52.CrossRefPubMedGoogle Scholar
  28. 28.
    de Vries AL, Steensma TD, Cohen-Kettenis PT, VanderLaan DP, Zucker KJ. Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national, cross-clinic comparative analysis. Eur Child Adolesc Psychiatry. 2016;25(6):579–88.CrossRefPubMedGoogle Scholar
  29. 29.
    Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009;123(1):346–52.CrossRefPubMedGoogle Scholar
  30. 30.
    Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs. 2010;23(4):205–13.CrossRefPubMedGoogle Scholar
  31. 31.
    Hines M. Prenatal endocrine influences on sexual orientation and on sexually differentiated childhood behavior. Front Neuroendocrinol. 2011;32(2):170–82.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Steensma TD, Kreukels BPC, de Vries ALC, Cohen-Kettenis PT. Gender identity development in adolescence. Horm Behav. 2013;64(2):288–97.CrossRefPubMedGoogle Scholar
  33. 33.
    Wallien MSC, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008;47(12):1413–23.CrossRefPubMedGoogle Scholar
  34. 34.
    Steensma TD, McGuire JK, Kreukels BP, Beekman AJ, Cohen-Kettenis PT. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J Am Acad Child Adolesc Psychiatry. 2013;52(6):582–90.CrossRefPubMedGoogle Scholar
  35. 35.
    McConnell EA, Birkett MA, Mustanski B. Typologies of social support and associations with mental health outcomes among LGBT youth. LGBT Health. 2015;2(1):55–61.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Nuttbrock L, Hwahng S, Bockting W, Rosenblum A, Mason M, Macri M, et al. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. J Sex Res. 2010;47(1):12–23.CrossRefPubMedGoogle Scholar
  37. 37.
    Alessi EJ, Kahn S, Chatterji S. ‘The darkest times of my life’: recollections of child abuse among forced migrants persecuted because of their sexual orientation and gender identity. Child Abuse Negl. 2016;51:93–105.CrossRefPubMedGoogle Scholar
  38. 38.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Egan SK, Perry DG. Gender identity: a multidimensional analysis with implications for psychosocial adjustment. Dev Psychol. 2001;37(4):451–63.CrossRefPubMedGoogle Scholar
  40. 40.
    McHale SM, Kim JY, Dotterer AM, Crouter AC, Booth A. The development of gendered interests and personality qualities from middle childhood through adolescence: a biosocial analysis. Child Dev. 2009;80(2):482–95.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Daniolos PT. Gender identity: on being versus wishing. J Am Acad Child Adolesc Psychiatry. 2013;52(6):569–71.CrossRefPubMedGoogle Scholar
  42. 42.
    Daniolos PT, Telingator CJ. Engendering identity. J Am Acad Child Adolesc Psychiatry. 2013;52(12):1245–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Goffman E. Stigma; notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall; 1963. p. 147.Google Scholar
  44. 44.
    Warriner K, Nagoshi CT, Nagoshi JL. Correlates of homophobia, transphobia, and internalized homophobia in gay or lesbian and heterosexual samples. J Homosex. 2013;60(9):1297–314.CrossRefPubMedGoogle Scholar
  45. 45.
    Margolies L, Becker M, Jackson-Brewer K. Internalized homophobia: identifying and treating the oppressor within. In: Collectives B, editor. Lesbian psychologies: explorations and challenges. Chicago, IL: University of Illinois Press; 1987. p. 229–42.Google Scholar
  46. 46.
    Perez-Brumer A, Hatzenbuehler ML, Oldenburg CE, Bockting W. Individual- and structural-level risk factors for suicide attempts among transgender adults. Behav Med. 2015;41(3):164–71.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Marshall BD, Socias ME, Kerr T, Zalazar V, Sued O, Aristegui I. Prevalence and correlates of lifetime suicide attempts among transgender persons in Argentina. J Homosex. 2016;63(7): 955–67.CrossRefPubMedGoogle Scholar
  48. 48.
    Hatzenbuehler ML. How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychol Bull. 2009;135(5):707–30.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Radkowsky M, Siegel LJ. The gay adolescent: stressors, adaptations, and psychosocial interventions. Clin Psychol Rev. 1997;17(2):191–216.CrossRefPubMedGoogle Scholar
  50. 50.
    SAMHSA (Substance Abuse and Mental Health Services Administration). A practitioner’s resource guide: helping families to support their LGBT children (Contract No.: HS Publication No. PEP14-LGBTKIDS). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.Google Scholar
  51. 51.
    Dierckx M, Motmans J, Mortelmans D, T’sjoen G. Families in transition: a literature review. Int Rev Psychiatry. 2016;28(1):36–43.CrossRefPubMedGoogle Scholar
  52. 52.
    Erikson EH. Childhood and society. New York, NY: Norton; 1963.Google Scholar
  53. 53.
    Leibowitz S, Chen D, Marco AH. Gender dysphoria and nonconformity. In: Dulcan MK, editor. Dulcan’s textbook of child and adolescent psychiatry. 2nd ed. Arlington, VA: American Psychiatric Association; 2016. p. 585–602.Google Scholar
  54. 54.
    Leibowitz S, de Vries AL. Gender dysphoria in adolescence. Int Rev Psychiatry. 2016;28(1):21–35.CrossRefPubMedGoogle Scholar
  55. 55.
    Bockting WO. Vulnerability and resilience among gender-nonconforming children and adolescents: mental health professionals have a key role to play. J Am Acad Child Adolesc Psychiatry. 2016;55(6):441–3.CrossRefPubMedGoogle Scholar
  56. 56.
    Adelson SL. Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2012;51(9):957–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Child and Adolescent PsychiatryUniversity of Iowa Stead Family Children’s HospitalIowa CityUSA

Personalised recommendations