On Wednesday, Florida Gov. Ron DeSantis (R) signed into law four different measures attacking LGBTQ+ rights. One of them bars minors from receiving gender-affirming care, blocks health insurance from covering such care for adults, and prohibits trans people from changing the sex indicated on their birth certificates. Another says that adults can be criminally charged if they don’t use the bathroom that matches the sex they were assigned at birth.
It’s little wonder that in the current landscape, and at a time when teens are facing unprecedented mental health challenges, trans youth in particular are at risk. A 2022 survey of almost 34,000 LGBTQ youth ages 13 to 24, conducted by the Trevor Project, found that almost two-thirds of trans and nonbinary youth reported symptoms of depression in the past year, and nearly 1 in 5 trans and nonbinary young people had attempted suicide in the past year. Rates were even higher for young people of color.
Not every mental health issue that a trans teen faces is necessarily related to their gender identity. However, as the above data shows, trans teens are disproportionately affected by depression and thoughts of suicide. To be clear, it’s not being trans that puts these young people at such alarming risk. Rather, it’s the discrimination and the transphobia they face. In addition to the usual ups and downs of adolescence, trans teens often face outright hostility in their communities, their schools and even their homes.
“While some may need specific assistance with gender-related issues, such as gender dysphoria [identifying as a gender other than your assigned sex], others may be seeking help with depression, anxiety, or other mental health concerns,” Caroline Fenkel, a trained social worker who oversees programming at Charlie Health, a mental health care provider for teens, told HuffPost.
Fenkel cites a study recently published in The Journal of the American Medical Association showing that gender-affirming care — that is, helping kids to transition, socially and/or medically (using puberty blockers or hormones) ― “was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up” in 104 trans or nonbinary youth ages 13 to 20.
Meeting kids where they’re at with their gender identity, and supporting their transition in a way that feels right to them, seems to mitigate some of the mental health risk they face.
HuffPost spoke to young trans people, and mental health professionals who work with them, about what trans people need when it comes to their mental health, and ways to offer this support.
Passion Childs is a 22-year-old living in Detroit who identifies as a nonbinary trans woman. She became depressed while working full-time after high school.
“It got to the point where it was very scary, because I genuinely wanted to be happy. But I just couldn’t be happy,” Childs told HuffPost.
One day, Childs came across a video of a woman talking about her transition and was struck by how well she passed.
“I started to question myself,” Childs said. She had a boyfriend in high school who disapproved of her wearing makeup or playing up her femininity in other ways. When Childs confided in him that she wanted a vagina, “he would look at me crazy. And I was so serious. But it was always in the back of my head because I felt like it would just never happen.”
Far from being impulsive, Childs’ decision was preceded by years of longing and another month of internal questioning after she finally identified her desire.
“I was thinking about it for a long time, and I really feel like this is who I am,” she explained. Characteristics like the way she walks and gestures with her hands made sense in this new context. Childs decided: “I don’t want to live with any regrets.”
She told her brother, who also identifies as queer, and he was accepting. For her birthday, her brother and his friend bought her a wig and makeup. “Honestly, it was the best birthday ever.”
“I started socially transitioning and it was the best decision I’ve ever made in my life to this day,” Childs said.
While she felt certain she was becoming a truer version of herself, transitioning hasn’t been an entirely easy experience.
“I was walking to my door and my neighbors were taking pictures of me and they were calling me names, [saying] that they know that I have on a wig, calling me a bitch. And after that, I went into a deep depression. I started self-harming again,” said Childs, who had periods of cutting her arms prior to her transition.
Looking back, she believes she was cutting “because I just didn’t feel real. I felt like I didn’t matter. I just felt — I don’t know. It was a low point in my life and in my transition.”
Her grandmother, who she was living with at the time, didn’t understand what she was going through and wasn’t helpful.
Childs ended up hospitalized in a psychiatric ward. She says that it was among the other patients there — “a very diverse, open and accepting group” — that she found the support she needed to get through this difficult period.
She has now been taking hormones for a year and half, and recently had top surgery. She’s happy with these physical elements of her transition, but she still faces obstacles related to passing, like being misgendered in the workplace. “It really messes with me, mentally,” Childs said.
“I struggle with confidence, my self-esteem,” she continued. “I’m just afraid of letting anyone see me without makeup.”
These days, she has a small group of trans friends whom she feels close to and can call on for support. She went to therapy in conjunction with her hormone treatment, and is participating in art therapy at the Ruth Ellis Center, a Detroit organization providing trauma-informed services for LGBTQ+ youth.
Last week, she says, she made a “dream box.”
“I put things that I want out of life inside of it,” Childs said, including getting married one day and having a pet. “I just want the life that I deserve.”
Lee, 18, is another young trans person who has found support at the Ruth Ellis Center. He told HuffPost that he remembers feeling like there was something different about him as early as perhaps age 4 or age 6, but he didn’t come out to his parents until he was 12 or 13.
While his mother was supportive, his father was not, initially, nor were other members of the family.
“My mental health wasn’t the best around that time, since I was denied mostly what I needed,” said Lee. Not being able to access gender-affirming care, he said, “drove my mental state worse.”
Lee said he is now doing much better thanks to the support of his mom and the Ruth Ellis Center. “They have been a great help and left a big impact on my life,” he said. “My mental health needs are being met.”
He says he wishes parents understood that having a trans kid “doesn’t mean that you lost your kid ― they just found themselves in a way that shows who they are.”
Trans teens, said Lee, “are in more need of support than discrimination. Hopefully people will realize it without backlash.”
How parents can offer support
Katie Horton is a registered mental health counseling intern working toward her license. She has been in practice for two years in Florida. Horton, who is trans, said that after earning her master’s degree on the West Coast, “[I] wanted to open my practice here, because this is where I came out.”
Many of her clients are also trans, and given the onslaught of anti-LGBTQ legislation, Florida is perhaps the most hostile place in the U.S. for trans people right now. This hostility and lack of acceptance causes stress for trans teens. Without support, they’re more likely to turn to behaviors like substance abuse and cutting, which Horton says is not uncommon among the young people she works with.
It’s a “coping mechanism,” she explained, “when you’re feeling so much and something makes you feel numb, and then it becomes addictive and that becomes harder and harder to stop.”
She continued, “When you don’t have an outlet for support, when you don’t have an outlet and understanding of what resources are out there so you can connect with others and not feel alone — then it makes sense. It makes sense that people go to those places and get stuck in them.”
The statistics on self-harm and suicidal thoughts in trans teens are alarming, but the good news is that parents can make a difference by showing their support and getting their child some resources. Horton says she has seen patients’ depression and anxiety improve when they find a safe space, whether that’s in therapy or elsewhere.
“This is not an experience many parents have been through, and there’s no expectations that they should know how to deal with it,” Horton said. But, she explained, “being able to sit in with your child during a [therapy] session and ask these questions, and get that connection and that equality in a relationship between child and parent,” shows that you are in this with them.
Finding community, whether it’s in support groups specifically for trans youth or a “Dungeons & Dragons” group that’s a safe space for gender-nonconforming teens, is also important, says Horton. Online communities like Discord are another place where she’s seen trans teens find a sense of belonging.
In addition to helping teens find those safe spaces, Horton says the biggest thing that parents can do to show their support is to listen to their child. Horton recommends letting your child guide the conversation.
“Ask them, ‘What does it mean to be an ally?’” she suggested. “You may be the only person in their life to take their gender identity and their expression seriously.”
This doesn’t mean you have to become an expert in trans issues overnight, but try to show that you are open to learning and making an effort. There are lots of organizations that have useful resources, including PFLAG, the Family Acceptance Project and Gender Spectrum. You can also check out “The Transgender Teen,” a “handbook for parents and professionals.”
Helping your teen get their hair cut or styled, or helping them find and purchase clothing they feel comfortable in, are other ways to show up for your child.
You also need to “acknowledge mistakes,” Horton said. “If you mess up, acknowledge [it], be willing to correct yourself, move on and practice.”
If you misgender your teen, for example, correct yourself and move on without making a big deal out of it. If you are too apologetic, you may make them feel like they need to tend to your emotional reaction instead of experiencing their own.
Horton has also noticed parents getting pushback from their kids for “sharing someone else’s story.” For example, you wouldn’t want to blast your social media with the news that your child is changing their name and pronouns if your child isn’t ready for this information to go public.
“It’s letting your kids tell their narrative,” Horton explained. Let them know you understand that “gender is complicated and it can take time.”
The words they use to identify and describe themselves may evolve and change as they grow into their individual identity, and you want them to feel safe sharing any new developments or understandings with you. Your role is not to provide all the answers, but to ensure that your child feels heard.
If you or someone you know needs help, dial 988 or call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also get support via text by visiting suicidepreventionlifeline.org/chat. Additionally, you can find local mental health and crisis resources at dontcallthepolice.com. Outside of the U.S., please visit the International Association for Suicide Prevention.