Sexual and gender identity can be considered on a spectrum. An individual may identify at any point within this spectrum or outside of it entirely. Many feel they are either male or female, and some feel like a masculine female or a feminine male. 

Others feel neither male nor female and may choose to describe themselves as gender fluid or genderqueer, with their gender changing from time to time. Such feelings about gender identity begin as early as ages 2 or 3.

Gender expression can depend on how individuals feel at different moments or in different cultural and social contexts. Historically, it was assumed to be fixed: all males are or should be masculine, all females feminine. Still today, many cultures set rigid expectations for acceptable gender behavior. People define themselves through all these lenses: by how they see themselves in society, how they may choose to identify with a sexual orientation, or how they express themselves and feel romantic and sexual attractions to others.

Some people’s assigned sex and gender identity are much the same (cisgender), while others’ personal sense of gender may not always correlate with their birth sex (transgender). Not all trans individuals choose to or have the option to transition with the help of medications or surgery. Gender expression through behavior and dress becomes important to self-identity and central to mental health and wellbeing.

As individuals come of age and grapple with their sexual and gender identify, seeking professional help can assuage doubts, deal with troubling issues or with anxiety or depression before they become aggravated conditions and simply help open pathways toward a rich and fulfilling life.

Research shows an association between LGB orientation and mental health, including suicide attempts, eating disorders, substance-use disorders, panic attacks, depression and anxiety disorders. Traumatic experiences of simply being a child in the world (parental divorce, death, abuse, etc.) are increased for LGBTQ+ youth, including overt hate crimes, bullying and parental rejection or abandonment, as well as more subtle microaggressions. 

One study identified minority stress reactions as resulting from:

• • Objective experiences of stigma, prejudice and discrimination
  • Maintaining constant vigilance in the expectation of discrimination 
  • Internalizing negative social attitudes
  • Concealing sexual orientation or gender expression in public

Social pressures and more specifically targeted abuse would be difficult for any young person to face alone, but the stigma of being singled out due to sexual orientation or gender expression can make coping alone intolerable. A psychologist trained in LGBTQ+ mental health can help direct individuals to targeted therapies and support, to alleviate symptoms and find community. 

Some youth may feel the incongruence of their gender identity and sex assigned at birth. More than not conforming to stereotypical gender role behavior, individuals may develop a gender identity disorder (GID) if they show a marked and persistent identification with the opposite sex and persistent discomfort (gender dysphoria) with their own sex or sense of inappropriateness in the gender role of that sex.

Transgender people experience high rates of physical and non-physical abuse and are also 3 times more likely than the broader population to experience depression. Their fears and conflicts may lead them to deny their gender or live a hidden life, increasing the risk of anxiety, depression, suicide, self-harm and other social or academic problems. 

When a strong desire to be a different gender causes significant distress and makes it difficult to enjoy life or do normal activities, trans people might be interested in exploring hormone blockers, hormone replacement therapy and/or surgical options. What suits one person may not suit another. These steps are life-changing decisions that can cause irreversible permanent changes, even if the process is discontinued. 

Learn more about LGBTQ+ Mental Health Resources at CFI…

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