Mental health problems are extremely common in the general population so it comes as no surprise that a number of common mental health conditions are also prevalent amongst transsexuals.

Mental illness does not preclude individuals from seeking specialist assessment and treatment for gender transition but severe illness is of concern if it is left untreated. As psychological stability is one of the main prognostic factors for a positive outcome after gender reassignment surgery, it is vital that the mental health needs of the individual are addressed at the earliest opportunity and the right amount of support given throughout transition.

Emotional problems are extremely common and can be considered as a normal adjustment reaction to such a major life event. Gender dysphoria, in itself, is unpleasent and distressing with a clear treatment that involves a carefully planned and supported gender transition. More information about this can be found on the Emotional Problems page.

Anxiety and Depression

Anxiety and Depression is common, particularly at the more stressful life events, such as coming out, the first assessment, managing the Real Life Experience and around the time of the surgery. It is important to maintain close links with your local doctor who can access support from the local mental health team in your area and work closely with the specialist gender services. Treatments for these disorders may include some specialist talking therapies and, for some, antidepressant medication. These treatments are very important and will not obstruct individuals from achieving their goals regarding gender transition. Not accessing help is of concern to health professionals, particularly in the case of more severe depressive disorders with suicidal feelings and impluses. Furthermore, the treatments are essential in identifying the need for extra support throughout the whole process and are likely to increase the chances of a safe and happy gender transition.

Psychotic disorders

Psychotic illnesses are less common but, without ongoing treatment, can be very disabling. Transsexuals with psychotic disorders, such as schizohphrenia, can still seek gender specialist assessment and treatment but there will be the expectation from the gender services that the individual will remain engaged with the local mental health team. Transition is a stressful experience and psychological stability is extremely important in order to achieve a good outcome after hormone treatment and surgery, so it may be that the gender services and mental health team choose to work closely together to support the individual through the changes.

Drug and Alcohol problems

Drug and alcohol problems are concerning for a number of reasons and need to be addressed as early as possible. Gender transition involves permanent physical changes through hormone treatment and surgery and so the health professionals need to be certain that the individual is making sensible choices. This is hard to assess if there is regular street drug use or heavy alcohol consumption. Also hormone treatment carries health risks and side effects that are significantly higher in those people who use alcohol above normal limits. Liver problems secondary to chronic alcohol misuse may even make hormone treatment dangerous and therefore is contraindicated. Futhermore, there are extra anaesethic risks and post-operative complications in those that use street drugs and alcohol and so ongoing use is likely to delay surgery or lead to extra problems. Therefore it is vitally important that these issues are managed at the earliest opportunity, for emotional and physical reasons and to prevent delay of specialist gender treatment.

Other disorders affecting mental capacity

As gender treatment involves permanent physical changes and major surgery, it is important that individuals undergoing such treatments are able to fully understand the risks, limitations and likely benefits. If an individual is not able to make an informed decision about these issues or is not able to fully understand, believe or retain the relevant information, then they are deemed as lacking mental capacity. Clearly this has serious implications for long-term treatment and carries risks in terms of regret and psychological stability. That is why there are robust strategies in place, including the psychiatric asssessment and a protracted assessment process and RLE with the specialist gender services. Some conditions, such as severe mental illnesses (such as severe depression or psychotic illnesses) or memory-problems (such as dementia), can be associated with diminished mental capacity and therefore need to be addressed with the support of the local doctors and, if necessary, mental health teams.

Have you or anyone you know experienced mental health problems before, during or after transition? Tell us your own experiences in the Blog