The Impact of Social, Legal and Medical Transition on Psychological Distress for Transgender Persons

Authors

DOI:

https://doi.org/10.18060/27640

Keywords:

transition, transgender, protective factors, psychological distress

Abstract

Psychological distress is a major health concern for transgender persons going through the transition process. The purpose of this secondary data analysis of the United States Transgender Survey (USTS) compiled by the National Center for Transgender Equality was to explore the relationship between the three stages of transition (social, legal, medical) and levels of psychological distress. While much of the current social work research focuses on risk factors related to psychological distress, particularly around discrimination, this study explores how each stage of transition can serve as a protective factor to increase overall well-being. Independent sample t-tests, ANOVA, and regressions were completed to determine if social, legal, and/or medical transition had a significant effect on psychological distress. Findings indicated that improving access to services supporting transition can reduce psychological distress. Implications for social work education and practice are provided. 

Author Biographies

Wade Luquet, Gwynedd Mercy University

Wade Luquet is professor of social work at Gwynedd Mercy University

Alex Redcay, Millersville University

Alex Redcay is associate professor of Social Work at Millersville University

Beth Counselman-Carpenter, Adelphi University

Beth Counselman-Carpenter is Associate Professor of Social Work at Adelphi University

References

Aitken, M., VanderLann, D., Wasserman, L., Stojanovski, S., & Zucker, K. (2016). Self-harm and suicidality in children referred for gender dysphoria. Journal of the American Academy of Children and Adolescent Psychiatry, 55, 513-520. https://doi.org/10.1016/j.jaac.2016.04.001

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70, 832-864. https://doi.org/10.1037/a0039906

Austin, A. (2018). Transgender and gender diverse children: Considerations for affirmative social work practice. Child & Adolescent Social Work Journal, 35(1), 73-84. https://doi.org/10.1007/s10560-017-0507-3

Barbee, H., Deal, C., & Gonzales, G. (2022). Anti-transgender legislation—A public health concern for transgender youth. JAMA Pediatrics, 176(2), 125-126. https://doi.org/10.1001/jamapediatrics.2021.4483

Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943-951. https://doi.org/10.2105/AJPH.2013.301241

Brecht, A., Bos, S., Ries, L., Winter, S. M., & Calvano, C. (2021). Assessment of psychological distress and peer relations among trans adolescents—An examination of the use gender norms and parent-child congruence of the YSR-R/CBCL-R among a treatment-seeking sample. Children, 8(10), 1-17. https://doi.org/10.3390/children8100864

Budge, S., Adelson, J., & Howard, K. (2013a). Anxiety and depression in transgender individuals: the roles of transition status, loss, social support & coping. Journal of Consulting and Clinical Psychology, 81, 545-557. https://doi.org/10.1037/a0031774

Budge, S., Rossman, H. K., & Howard, K. (2013b). Coping and psychological distress among genderqueer individual: The moderating effect of social support. Journal of LGBT Issues in Counseling, 8, 95-117. https://doi.org/10.1080/15538605.2014.853641

Bustos, V. P., Bustos, S. S., Mascaro, A., Del Corral, G., Forte, A. J., Ciudad, P., Kim, E. A., Langstein, H. N., & Manrique, O. J. (2021). Regret after gender-affirmation surgery: A systematic review and meta-analysis of prevalencev. Plastic and Reconstructive Surgery - Global Open, 9(3), 1-12. https://doi.org/10.1097/GOX.0000000000003477

Chang, S. C., Singh, A. A., & Dickey, L. M. (2018). A clinician’s guide to gender-affirming care: Working with transgender and gender-nonconforming clients. Context Press.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.

Collazo, A., Austin, A., & Craig, S. L. (2013). Facilitating transition among transgender clients: Components of effective clinical practicev. Clinical Social Work Journal, 41(3), 228-237. https://doi.org/10.1007/s10615-013-0436-3

Crissman, H., Stroumsa, D., Kopernik, E., & Berger, M. (2019). Gender and frequent mental mistress: comparing transgender and non-transgender individuals’ self-rated mental health. Journal of Women’s Health, 28, 143-151. https://doi.org/10.1089/jwh.2018.7411

Dawson, L., & Kates, J. (April 24, 2024). Policy tracker: Youth access to gender affirming care and state policy restrictions. Kaiser Family Foundation. https://www.kff.org/other/dashboard/gender-affirming-care-policy-tracker/

De Vries, A., Steensma, T., Doreleijers, T., & Cohen-Kettenis, P. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. The Journal of Sexual Medicine, 8, 2276-2283. https://doi.org/10.1111/j.1743-6109.2010.01943.x

Dentato, M. P., Kelly, B. L., Lloyd, M. R., & Busch, N. (2018). Preparing social workers for practice with LGBT populations affected by substance use: Perceptions from students, alumni, and service providers. Social Work Education, 37(3), 294-314. https://doi.org/10.1080/02615479.2017.1406467

Devor, A. (2004). Witnessing and mirroring: A 14-stage model of transgender identity formation. Journal of Gay & Lesbian Psychotherapy, 8, 41-67. https://doi.org/10.1080/19359705.2004.9962366

Durwood, L., McLaughlin, K., & Olson, K. (2018). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 116-123. https://doi.org/10.1016/j.jaac.2016.10.016

Fabbre, V. (2016). Queer aging: Implications for social work practice with lesbian, gay, bisexual, transgender, and queer older adultsv. Social Work, 62(1), 73-76. https://doi.org/10.1093/sw/sww076

Fien, L. A., Salgado, C. J., Alvarez, C. V., & Estes, C. M. (2017). Transitioning transgender: Investigating the important aspects of the transition: A brief report. International Journal of Sexual Health, 29, 80-88. https://doi.org/10.1080/19317611.2016.1227013

Gagne, P., & Tewksbury, R. (1998). Conformity pressures and gender resistance among transgendered individuals. Social Problems, 45, 81-101. https://doi.org/10.1525/sp.1998.45.1.03x0158b

Gagne, P., Tewksbury, R., & McGaughey, D. (1997). Coming out and crossing over: Identify formation and proclamation in a transgender community. Gender and Society, 11, 478-508. https://doi.org/10.1177/089124397011004006

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. National Center for Transgender Equality and National Gay and Lesbian Task Force. https://transequality.org/sites/default/files/docs/resources/NTDS_Report.pdf

Hajek, A., König, H. H., Blessmann, M., & Grupp, K. (2023). Loneliness and social isolation among transgender and gender diverse people. Healthcare, 11(10), 1-10. https://doi.org/10.3390/healthcare11101517

Hill, B. J., Crosby, R., Bouris, A., Brown, R., Bak, T., Rosentel, K., VandeVusse, A., Silverman, M., & Salazar, L. (2018). Exploring transgender legal name change as a potential structural intervention for mitigating social determinants of healthy among transgender women of color. Sexuality Research and Social Policy, 15, 25-33. https://doi.org/10.1007/s13178-017-0289-6

Hodax, J. K., Crouch, J. M., Sethness, J. L., Loren, D., Kahn, N. F., Asante, P. G., & Sequeira, G. M. (2023). Strategies for providing gender-affirming care for adolescents in the primary care setting. Pediatric Annals, 52(12), e442-e449. https://doi.org/10.3928/19382359-20231016-04

James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Executive Summary Of The Report Of The 2015 U.S. Transgender Survey. National Center for Transgender Equality. https://transequality.org/sites/default/files/docs/usts/USTS-Executive-Summary-Dec17.pdf

Johnson, A., McClurg, A., Baldino, J., Das, R., & Carey, E. (2024). Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons. Fertility and Sterility (F&S) Reports: American Society for Reproductive Medicine (ASRM), 5(1), 87-94 https://doi.org/10.1016/j.xfre.2023.12.002

Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L. T., Walters, E. E., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959-976. https://doi.org/10.1017/S0033291702006074

Lambda Legal. (2025). About us. https://www.lambdalegal.org/about-us

Lewis, C. P. (2017). The road to trans-inclusive health care: Policy implications and the critical role of social work. Health & Social Work, 42(1), 60-62. https://doi.org/10.1093/hsw/hlw056

Mallon, G. P. (2021). Strategies for child welfare professionals working with transgender and gender expansive youth. Jessica Kingsley Publishers. https://doi.org/10.5040/9781805015628

McCarty-Caplan, D. (2018). Seeing the same thing differently: Program director, faculty, and student perceptions of MSW LGBT competence. Journal of Social Work Education, 54(3), 448-463. https://doi.org/10.1080/10437797.2018.1453904

Millet, N., Longworth, J., & Arcelus, J. (2017). Prevalence of anxiety symptoms and disorders in the transgender population: A systematic review of the literature. International Journal of Transgenderism, 18(1), 27-38. https://doi.org/10.1080/15532739.2016.1258353

Movement Advancement Project. (2017, February). Mapping transgender equality in the United States. Author. https://www.lgbtmap.org/mapping-trans-equality

Murad, M., Elamin, M., Garcia, M., Mullan, R., Murad, A., Erwin, P., & Montori, V. (2010). Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology, 72, 214-231. https://doi.org/10.1111/j.1365-2265.2009.03625.x

National Association of Social Workers [NASW]. (2017). Code of ethics of the NASW. Author. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

National Center for Transgender Equality. (2023). Health coverage guide. https://transequality.org/health-coverage-guide

Nemoto, T., Bodeler, B., & Iwamoto, M. (2011). Social support, exposure to transphobia: Correlates of depression among male-to-female transgender women with a history of sex work. American Journal of Public Health, 101, 1980-1988. https://doi.org/10.2105/AJPH.2010.197285

Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., & Becker, J. (2010). Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. Journal of Sex Research, 47, 12-23. https://doi.org/10.1080/00224490903062258

Olson, K., Durwood, L., DeMeules, M., & McLaughlin, K. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137, 1-8. https://doi.org/10.1542/peds.2015-3223

Prochaska, J. J., Sung, H. Y., Max, W., Shi, Y., & Ong, M. (2012). Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. International Journal of Methods in Psychiatric Research, 21(2), 88-97. https://doi.org/10.1002/mpr.1349

Redcay, A., Counselman Carpenter, E., McMahon, S., Luquet, W., Rice, K., & Lance, R. (2019). The arc of justice: Advancing the human rights of transgender and gender expansive youth through challenging policies and laws. Journal of Human Rights and Social Work, 4, 156-163. https://doi.org/10.1007/s41134-019-00102-3

Sanchez, F., & Vilain, E. (2009). Collective self-esteem as a coping resource for male-to-female transsexual. Journal of Counseling Psychology, 56, 202-209. https://doi.org/10.1037/a0014573

Sherer, I. (2016). Social transition: Supporting our youngest transgender children. Pediatrics, 137(3), 1-2. https://doi.org/10.1542/peds.2015-4358

Spivey, L. A., & Edwards-Leeper, L. (2019). Future directions in affirmation psychological interventions with transgender children and adolescents. Journal of Clinical Child and Adolescent Psychology, 48, 342-256. https://doi.org/10.1080/15374416.2018.1534207

Spizzirri, G., Duran, F., Chaim-Avancini, T. M., Serpa, M. H., Cavallet, M., Pereira, C., Santos, P. P., Squarzoni, P., da Costa, N. A., Busatto, G. F., & Abdo, C. (2018). Grey and white matter volumes either in treatment-naïve or hormone-treated transgender women: A voxel-based morphometry study. Scientific Reports, 8(1), 1-10. https://doi.org/10.1038/s41598-017-17563-z

Stanton, M. C., Ali, S., & Chaudhuri, S. (2017). Individual, social and community-level predictors of wellbeing in a US sample of transgender and gender non-conforming individuals. Culture, Health & Sexuality, 19(1), 32-49. https://doi.org/10.1080/13691058.2016.1189596

Staples, J. M., Bird, E. R., Masters, T. N., & George, W. H. (2018a). Considerations for culturally sensitive research with transgender adults: A qualitative analysis. Journal of Sex Research, 55(8), 1065-1076. https://doi.org/10.1080/00224499.2017.1292419

Staples, J. M., Neilson, E. C., Bryan, A. E. B., & George, W. H. (2018b). The role of distal minority stress and internalized transnegativity in suicidal ideation and nonsuicidal self-injury among transgender adults . Journal of Sex Research, 55(4/5), 591-603. https://doi.org/10.1080/00224499.2017.1393651

Steensma, T. D., Kreukels, B. P. C., de Vries, A. L. C., & Cohen-Kettenis, P. T. (2013). Gender identity development in adolescence. Hormones and Behavior, 64(2), 288-297. https://doi.org/10.1016/j.yhbeh.2013.02.020

Timmins, L., Rimes, K.A., & Rahman, Q. (2017). Minority stressors and psychological distress in transgender individuals. Psychology of Sexual Orientation and Gender Diversity, 4(3), 328-340. https://doi.org/10.1037/sgd0000237

Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open, 5(2), 1-13. https://doi.org/10.1001/jamanetworkopen.2022.0978

Trevor Project. (n.d.). Home. Author. https://www.thetrevorproject.org/

Tsai, M., Lau, M., & Kuper, L. (2021). Health care transition of transgender youth. Pediatrics, 147, 605-605. https://doi.org/10.1542/peds.147.3MA6.605a

Uribe, C., Junque, C., Gómez-Gil, E., Abos, A., Mueller, S. C., & Guillamon, A. (2020). Brain network interactions in transgender individuals with gender incongruence. NeuroImage, 211, 1-12. https://doi.org/10.1016/j.neuroimage.2020.116613

White Holman, C. W., & Goldberg, J. M. (2006). Social and medical transgender case advocacy. International Journal of Transgenderism, 9(3-4), 197-217. https://doi.org/10.1300/J485v09n03_09

White Hughto, J. M., Pachankis, J. E., Willie, T. C., & Reisner, S. L. (2017). Victimization and depressive symptomology in transgender adults: The mediating role of avoidant coping. Journal of Counseling Psychology, 64(1), 41-51. https://doi.org/10.1037/cou0000184

Wilson, E., Chen, Y., Arayasirikul, S., Wenzel, C., & Raymond, H. (2015). Connecting the dots: Examining transgender women's utilization of transition-related medical care and associations with mental health, substance abuse and HIV. Journal of Urban Health, 92, 182-192. https://doi.org/10.1007/s11524-014-9921-4

World Health Organization. (2019). International classification of diseases (ICD-11). Author. https://icd.who.int/en

Downloads

Published

2025-07-09