‘The young people feel it’: A look at the mental health impact of transgender legislation

Ongoing legislation regulating gender-affirming care is raising concern among psychologists about the impact on the mental health of trans individuals—in particular children and teens—as well as other members of the LGBTQ+ community.

Research overwhelmingly shows these bills and laws, which target access to health care, sports participation, and school policies, have resulted in heightened levels of anxiety, depression, and suicide risk among LGBTQ+ youth.

A 2024 national survey from the Trevor Projectopens in new window, for example, found an overwhelming majority (90%) of LGBTQ+ young people said their well-being was negatively impacted due to recent politics. Over half (53%) said their well-being was negatively impacted by politics a lot. In addition, nearly half (45%) of transgender and nonbinary youth reported that they or their family have considered moving to a different state due to anti-LGBTQ+ politics and laws.

The American Civil Liberties Union is currently tracking 515 anti-LGBTQ billsopens in new window in the United States. Across the United States, 25 states have adopted laws or policies that ban or severely limit gender-affirming care for minors, and several others are eyeing the possibility. Approximately 113,900 transgender youth—more than a third of transgender youth in the U.S.—live in states that have enacted bans on access to gender-affirming careopens in new window, according to an April 2024 report by The Williams Institute at the law school of the University of California, Los Angeles.

Last year Florida clinical psychologist Gary Howell, PsyD, hospitalized a host of teenage transgender clients struggling as a result of these bans.

“These teens were all suicidal specifically because of the legislative moves happening in Tallahassee, the state capitol,” said Howell, who noted that the teens were all planning to begin taking puberty blockers, only to be told they would not be able to move forward with those plans. “I’m seeing a lot more depression, anxiety, and suicidality these days.”

A 2022 study of gender-diverse youth published by the Journal of Family Psychology showed families fear for the safety of their trans and nonbinary youthopens in new window and are fleeing states where these bills are being passed.

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For many years research revealed that trans and nonbinary people who live in areas with more inclusive policies and greater protections have overall better mental healthopens in new window, but even that is being challenged today: A 2023 study coauthored by industrial-organizational psychologist Lindsay Dhanani, PhD, and Amherst College psychology professor Rebecca Totton, PhD, found all trans people are at risk of experiencing negative outcomesopens in new window, including increased risk of suicide, because these bills are being heard and shared around the country.

In response, members of these already marginalized communities and their families are finding ways to build connections and advocate for their rights. New research in the journal Psychology of Sexual Orientation and Gender Diversity suggests sexual minorities who participate in LGBTQ activism tend to have enhanced psychological well-beingopens in new window. The study indicates that meaning in life, problem-solving coping strategies, and community connection play a key role in this relationship.

Proponents say the bans protect children from medical treatments they see as harmful and unproven. But that stance defies much of the medical establishment, which views the care as medically necessary and beneficial for some children who have gender dysphoria.

Recent surveys indicate that this increase in anti-LGBTQ rhetoric and legislative concerns is taking a grim toll. Approximately 39% of LGBTQ young people seriously considered attempting suicide in the past year, including almost half of transgender and nonbinary young people (46%) and three in 10 cisgender young people, according to a 2024 report from the Trevor Project. LGBTQ+ youth of color reported higher rates than White peers. The report surveyed more than 18,000 LGBTQ+ young people aged 13 to 24 across the United States. The same survey found 50% of LGBTQ+ young people who wanted mental health care in the past year were not able to get it.

Mental health experts back up these findings. “Young trans people today are experiencing a tremendous amount of anxiety,” said APA Past President Thema Bryant, PhD. “There is a sense of not feeling safe. This increased sense of animosity toward this already vulnerable population is even affecting those living in states where antitransgender legislation isn’t even on the table.”

[Related: Best practices for mental health facilities working with LGBTQ clients]

While the harmful direct health implications of not having access to gender-affirming careopens in new window are well documented, Dhanani and Totton’s 2023 study in Sexuality Research and Social Policy examined the indirect, or holistic, harm of the mere existence of these types of legislation. She found perceived support for the legislation was associated with greater rumination, depressive symptoms, physical health symptoms, and fear of disclosing one’s identity. Notably, many respondents said that lack of access to gender-affirming care would cause them to experience suicidal ideation. Some said gender-affirming care had "saved my life."

“Our findings show that it’s not enough to say ‘under these bills, if they were passed, X number of trans people wouldn’t have access to gender-affirming care,’” Dhanani said. “What we actually find is that everyone who is a member of the trans community is at risk of being harmed, simply because these bills exist—simply because people are spending time and engaging in rhetoric around the trans community that is stigmatizing, because they’re signaling that these folks don’t have the rights that other folks have.”

The study included a national sample of 113 trans youth and young adults, and she noted it didn’t matter where a participant resided when it came to experiencing negative mental health outcomes.

Colorado private practitioner Sarah Burgamy, PsyD, who works with transgender and nonbinary children and adults, has seen this play out in her state, where she is seeing a mixed bag of reactions from clients—relief to be living where they do, but also a growing awareness that where they live does not, in effect, keep them “safe.”

Her young clients have been hit the hardest, since they aren’t yet equipped with the ability to shield themselves against some of what they are seeing and hearing, as many adults might be, she said.

“The young people feel it in their bones—they think people hate the very person they are and everything about them, and are listening to people tell them they’re not allowed to be themselves,” she said. “I’ve seen self-harm go through the roof and suicidal ideation is up. It’s beyond rhetoric—the actions taken to almost erase the existence of many of these young people who are just coming into their identities for the first time in their lives. It’s grim.”

Burgamy said the number of families reaching out to her who have moved to Colorado from other states for their children to access gender-affirming care continues to grow. 

“The idea that so many people are picking up and relocating their whole families because they don’t have access to healthcare—inclusive of psychological care that’s needed—is just mind-blowing,” Burgamy said. “Plus, as we continue to see an influx of people to states that do provide access to this care, we’re starting to see a vacuum of availability of services, which is only going to get worse.”

Burgamy said one of the ways she works with clients to help them cope is by reminding them psychological science is on their side.

“I remind them that this is human diversity, and they are exactly who they are meant to be and it’s not problematic, it’s not mental illness, it is normative, human identity, whether they’re gender diverse or their sexual orientation is diverse,” she said.

She also points to positive developments in the past year, including APA’s adoption in February of 2024 of a groundbreaking policy affirming evidence-based care for transgender, gender diverse, and nonbinary children, adolescents, and adults. As a council representative of Division 44 (Society for the Psychology of Sexual Orientation and Gender Diversity), Burgamy was a critical team member who helped pass this new policy. She often highlights this policy and its intent to combat misinformation when she is working with clients experiencing gender-related distress.

She continues to be inspired by the resilience of her young clients in the face of these ongoing attacks on their sense of self. She encourages a focus on connection among her clients, and works closely with them to ensure those who are struggling are able to find support.

“Every day of the week I tell people, ‘Don’t get isolated, don’t worry alone,” Burgamy said. “That’s a big piece of it.”

[Related: Advocating for transgender and nonbinary youths]

Howell said for the first time he has also seen parents of his LGBTQ+ clients are becoming much more mindful about orchestrating family events that include other families who are struggling with the same issues. Many of his adult trans clients have also become activists for the first time, even those who never had a desire to get involved in advocacy work.

Research suggests this approach may protect against some of the negative mental health effects of anti-LGBTQ legislation. In a 2023 Psychology of Sexual Orientation and Gender Diversity study of more than 500 sexual minority individuals, researchers found participation in LGBTQ+ activism enhanced participants’ sense of meaning in life, encouraged community connection, and facilitated problem-solving coping strategies—all important factors that may contribute to positive psychological outcomes.

“Some people really do benefit from getting active in the cause,” Burgamy said. “That can be doing things like writing a letter to or even meeting with their legislators, protesting, or joining an advocacy group. For other folks it’s more about the connection, and they don’t have a lot of interest in engaging in what feels like battling.”

[Related: Resources for grassroots and state-level advocacy on LGBTQ+ issues]

Angelique Godwin, a Black and Hispanic trans woman in Florida, agrees peacefully protesting the latest surge in the state’s anti-trans legislation has helped her connect with others and benefitted her own mental health. Godwin has been involved in several events through LGBTQ+ advocacy group Equality Florida, including an April drag queen march to the steps of the Florida statehouse to protest Republican Governor Ron DeSantis and state GOP lawmakers’ efforts to limit LGBTQ+ rights.

“We are stronger together than we are apart,” Godwin said. “Don’t let them tell you how to do you.”