Mental Health Care | FAQs
Q | Does Transforming Choices provide crisis support?
Transforming Choices does NOT provide crisis support. If you are in crisis or need support right away:
Dial 911 or Call, text, or chat 988→.
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Note. Calling 911 or 988 could result in law enforcement involvement.
Call a non-carceral support line (law enforcement NOT involved):
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Trans Lifeline→ 877.565.8860 (call Mon-Fri 1p-9p ET)
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The Trevor Project Suicide Hotline→ [ages 13-24]: 866.488.7386 (call, chat, or text 24/7)
If you need support and you are not in danger of hurting yourself or others, check out:
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BlackLine→ 800.604.5841 (call or text Mon-Fri 9a-5p, Sat-Sun 7p-11p ET)
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LGBT National Hotline→ 888.843.4564 (call Mon-Fri 2p-11p PT, Sat 12p-5p ET)
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THRIVE Lifeline→ (chat Wed-Thu 10:30pm-4:30am PT)
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Q | What should I know about getting support for my mental health and well-being?
With transphobia and anti-trans policies on the rise, coping with everyday life stressors may be more difficult for trans and gender-expansive people. It is important to reach out to members of your community and to trained professionals if you need support.* Consider individual counseling, peer support groups, reaching out to a clinic or medical office, or calling a support line. For caregivers of people with serious illness, consider joining a care partner support group to prevent burnout.
Example. A gender-expansive person who cares for their ailing spouse joins an LGBTQIA+ friendly care partner support group.
*If you are having thoughts of hurting yourself, seek emergency care right away. See crisis resources.
Q | What is therapy and how can it help me?
Therapy is psychological counseling provided by a qualified professional to help you understand and cope with life stressors, trauma, and/or mental health conditions like depression, anxiety, or bipolar disorder. Trans adults face stigma, trauma, and mental health challenges at higher rates than cisgender adults, so therapy can be an important part of coping and healing. A therapist may be able to help you:
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Understand and affirm your gender identity and expression.
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Anticipate and help manage concerns about societal interactions after your transition.
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Understand how difficult or traumatic past experiences impact your current thoughts and actions.
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Reframe negative ways of thinking to reduce negative self-talk and boost self-esteem.
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Guide your healing process from trauma and grief.
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Manage depression, anxiety, bipolar disorder, and other mental health diagnoses.
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Manage conditions like eating disorders, obsessive compulsive disorder, and personality disorders.
…and more.
Working with a knowledgeable and affirming therapist can have a tremendous impact on your health and wellbeing and can even be lifesaving.
Example. An older trans woman sees a therapist who helps her embrace her gender identity after suppressing it her entire life.
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Wanta JW, Niforatos JD, Durbak E, Viguera A, Altinay M. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgend Health. 2019;4(1):313-315. Published 2019 Nov 1. doi:10.1089/trgh.2019.0029
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Q | How can I find an LGBTQIA+ friendly therapist?
Finding an affirming therapist with knowledge of mental healthcare for trans adults can be difficult due to limited availability, cost, lack of insurance coverage, and inadequate training among providers. But it’s still possible! To find an affirming therapist:
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Ask people in your support network who have transitioned about their own experience and recommendations.
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Search for therapists online who have experience working with patients in the LGBTQIA+ community.
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Consider telehealth therapy if you can’t find a therapist in your area.
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Contact LGBTQIA+ community organizations that can connect you to counseling services.
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Look for counseling resources at LGBTQIA+ or health-focused community events.
There are many different kinds of therapy available. You may or may not know which kinds of therapy you need, and that’s ok. It can take time to find out what would work best for you. For example, you could have a good relationship with your therapist, who is helping you manage gender dysphoria, but they don’t have specialized training in techniques like EMDR that address past trauma. You may decide to see a therapist with trauma-focused training while continuing on with your current therapist or you may decide to change therapists. You may not find the right therapist on the first, second, or even third try, as this trans woman explained:
It took four different therapists for me to find the right one, not just one who would shove me in the direction she thought best.
If you're hitting roadblocks in your search, keep trying because not only is it worth it, but it could also be lifesaving. Consider the LGBTQ+ Healthcare Directory→ or OutList→ to help you in your search.
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Q | What is spiritual wellbeing and why is it important?
Spiritual wellbeing is having a sense of purpose or meaning in life and having a set of guiding values and principles. To care for your spiritual wellbeing, you can:
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Reflect on what brings meaning to your life.
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Spend time in nature.
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Make art, write, and be creative.
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Volunteer and show kindness to others.
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Take care of your physical and mental health.
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Seek wisdom or enlightenment.
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Practice meditation, prayer, and other forms of mindfulness.
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Join a faith community.
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Speak with a faith leader or spiritual guide.
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Seek advice from your transition support group or online communities.
Spirituality is different from religion, which is an organized system of beliefs and practices often focused on a God or gods. Some religious groups have been hostile to trans and gender-expansive people, and many trans people have had to hide their gender identity or face stigma and abuse in the name of religion. However, many faith communities are accepting and affirming and can be an important source of support and spiritual expression for trans folks. For some trans people, spiritual exploration is part of their gender transition journey, and faith in a higher power may be a source of hope and unconditional love.
Example. An older trans man finds purpose in his life by mentoring, housing, and otherwise supporting younger trans men who are struggling physically, mentally, and spiritually.
Example. A trans woman in hospice care, who is part of an Episcopalian faith community, requests last rites, a series of ministrations for people who are dying.
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Fabbre VD, Taylor CB, Sloan S, Gaveras E. Implicit and Explicit Spirituality in the Lives of Transgender and Gender Expansive Older Adults. J Gerontol Soc Work. 2023;66(8):1073-1089. doi:10.1080/01634372.2023.2207044
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Q | How do I cope with loneliness?
Gender transition is a deeply personal decision. In many cases, for those who choose to transition, it may result in significant alienation from friends, family and even lead to isolation or divorce. Knowing that, loneliness is a real concern for trans people. Loneliness can develop for many reasons, such as:
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You are estranged from your biological family.
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You are having trouble making new friends in older age.
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You are not able to leave your house any longer.
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You don’t have stable housing.
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You are in an elder care facility, and you don’t see anyone like you there.
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You lost a member of your chosen family due to illness or violence.
Although loneliness can be difficult to cope with, these tips may help you:
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Reach out to someone you care about even if you don’t feel up to it.
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Get involved in groups that align with your interests (like gardening, crocheting, woodworking).
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Connect with someone younger than you if you’re older or older than you if you’re younger.
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Join support groups online or in your area.
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Volunteer in your community.
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Stay involved with community and civic organizations if it is practical.
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Stay involved with your faith community.
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Use technology like social media, online forums, and apps to reach out to others.
Example. An older trans man who was living by himself and had been feeling lonely accepted an invitation from his neighbors to have dinner with them one evening, and they decided to have dinners every week from then on.
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Q | What should I consider about my mental health in retirement?
Retirement is a major transition with changes to your routine, your social life, and your sense of purpose. It can bring up feelings of excitement and relief, and it can bring up feelings of depression and anxiety. It is important to plan for how you want to get fulfillment out of your time in retirement to reduce possible risks to your mental health.
For more information, see a list of strategies for coping with the stress of retirement→ from the Harvard Business Review.
Q | What should I know about addiction and substance use conditions?
Many people in the LGBTQ+ community manage addiction and substance use conditions oftentimes as a way to cope with societal stressors and discrimination. Getting help can be challenging, but this resource from the National Alliance on Mental Illness (NAMI)→ may be a place to start.
Note. Substance Abuse and Mental Health Services Administration (SAMHSA) resources maintained by the federal government on substance use among LGBTQ+ people have been removed. However, SAMHSA addiction resources for the general public→ may still be helpful in locating substance use treatment options.
Q | How can I manage pain after surgery, including gender-affirming surgery, if I am in recovery from substance use?
Medical and nursing professional organizations support holistic and integrated management of pain and substance use conditions. This means that your healthcare providers should adequately treat your pain without disrupting progress you’ve made toward recovering from substance use disorder. You don’t have to give up your recovery to focus on your healthcare (and vice versa). If an opioid medication is the best treatment for you, your healthcare providers can consult with other team members specializing in pain and addiction management to plan for reducing your risk of relapse. Your healthcare providers may also suggest anti-inflammatory and non-medicinal pain management strategies, like physical therapy or acupuncture, depending on your level of pain and degree of healing after surgery. The plan to manage your pain and to protect your recovery after surgery should be unique to your needs. One way to protect your recovery from addiction and your recovery from surgery is to talk to your surgeon and other healthcare providers involved in your care about your concerns before your surgery during pre-op appointments. Ask them about the plan for managing your pain and whether that plan includes protections for your recovery from substance use.
Example. A trans woman, who has been in recovery from opioid addiction for about one year, is worried about relapsing if she is prescribed an opioid medication for post-op pain after top surgery. She talks to her healthcare team about ways to manage and reduce her pain that would reduce the use of opioids.
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Prince V. Pain Management in Patients with Substance-use Disorders. PSAP-VII Chron Illness. Retrieved from https://www.accp.com/docs/bookstore/psap/p7b05.sample03.pdf
Sowicz TJ, Compton P, Matteliano D, et al. Pain Management and Substance Use Disorders. Pain Manag Nurs. 2022;23(6):691-692. doi:10.1016/j.pmn.2022.08.015
Q | What is PTSD?
Posttraumatic stress disorder (PTSD) is a mental health condition that some people develop after they see or experience an extremely stressful or terrifying ordeal. Trans people are at higher risk of developing PTSD than cisgender people. This may be due to increased rates of interpersonal violence, suicide attempts, and ongoing exposure to microaggressions over time for trans people.
Example. A trans Veteran is meeting regularly with a specially trained therapist to manage his PTSD from traumatic combat experiences and anti-trans abuses while in the military.
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Marchi M, Travascio A, Uberti D, et al. Post-traumatic stress disorder among LGBTQ people: a systematic review and meta-analysis. Epidemiol Psychiatr Sci. 2023;32:e44. Published 2023 Jul 11. doi:10.1017/S2045796023000586
Q | What are the signs of abuse in a relationship?
Trans people are at higher risk for relationship abuse than cisgender people. The warning signs of abuse by a partner include:
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Showing extreme jealousy and preventing you from seeing other people
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Saying negative or hurtful things to you, especially in front of others
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Controlling your decisions and your finances
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Pressuring you into sexual activity you are not comfortable with
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Pressuring you to use drugs or alcohol
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Destroying your belongings
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Intimidating you with threats or weapons
To get more information and resources about relationship abuse and to get help, check out The Network La Red LGBTQ+ Hotline for People Experiencing Partner Abuse→
Other resources for survivors of abuse include:
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Peitzmeier SM, Malik M, Kattari SK, et al. Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates. Am J Public Health. 2020;110(9):e1-e14. doi:10.2105/AJPH.2020.305774
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Q | Where can I find information or get help after a traumatic experience?
Resources are available for trans people who have experienced trauma. Here are a few:
Q | What are some coping strategies I can use to support my mental health?
See below for a few coping strategies to try when you are feeling down or worried. If you are feeling symptoms of depression or anxiety, consider psychological counseling and medications to boost your mood or calm your mind.
Sources
Fabbre VD, Taylor CB, Sloan S, Gaveras E. Implicit and Explicit Spirituality in the Lives of Transgender and Gender Expansive Older Adults. J Gerontol Soc Work. 2023;66(8):1073-1089. doi:10.1080/01634372.2023.2207044
Marchi M, Travascio A, Uberti D, et al. Post-traumatic stress disorder among LGBTQ people: a systematic review and meta-analysis. Epidemiol Psychiatr Sci. 2023;32:e44. Published 2023 Jul 11. doi:10.1017/S2045796023000586
Peitzmeier SM, Malik M, Kattari SK, et al. Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates. Am J Public Health. 2020;110(9):e1-e14. doi:10.2105/AJPH.2020.305774
Prince V. Pain Management in Patients with Substance-use Disorders. PSAP-VII Chron Illness. Retrieved from https://www.accp.com/docs/bookstore/psap/p7b05.sample03.pdf
Sowicz TJ, Compton P, Matteliano D, et al. Pain Management and Substance Use Disorders. Pain Manag Nurs. 2022;23(6):691-692. doi:10.1016/j.pmn.2022.08.015
Wanta JW, Niforatos JD, Durbak E, Viguera A, Altinay M. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgend Health. 2019;4(1):313-315. Published 2019 Nov 1. doi:10.1089/trgh.2019.0029
Resources