Mental Health

The following section outlines the information that pertains to gender-affirming care in relation to mental health. This section is written material only, and will outline the role of the mental health provider vs. the role of PCPs, how to make affirming mental health referrals, and how to support and affirm the mental health of Two-Spirit, trans, Indigiqueer, and gender-diverse (2STIGD) folks. 

Mental health support is something that people of all genders might need at some point in our lives. While mental health for 2STIGD people is very similar to that of cisgender people, there are a few important differences. In order to support and affirm your patients, understanding some of these differences will go a long way to establish a trusting relationship. Over the years, many terms have been used by medical professionals to describe the experiences of some 2STIGD people’s experiences. These have included transsexualism (DSM-3), gender identity disorder (DSM-4), and gender dysphoria. As described in Section 2 the term gender dysphoria is the most recent diagnosis outlined in the DSM-5. The diagnosis of gender dysphoria was developed to more accurately reflect 2STIGD people’s experiences and still enable access to necessary health care.  However, it should be noted that while the diagnosis is often required to access care and coverage, it is not a term that all 2STIGD people identify with or accept. 

Therefore, while the diagnosis is often a prerequisite to care, it is important to emphasize that no one’s identity is a disorder. The historical, and sometimes contemporary, belief that gender diversity is a mental health condition is a myth that has been discredited multiple times over the last 30+ years. Although, 2STIGD people can shoulder a significant burden of poor mental health outcomes, compared to cisgender people broadly, these outcomes may or may not be related to their gender. It is important to note that at times the bodily discomfort, depression, and anxiety that is associated with a diagnosis of gender dysphoria can be attributable to external experiences of stigma, discrimination, and a lack of access to adequate care, rather than simply being linked to body dissonance. 

While 2STIGD people may require mental health support from PCPs (e.g., access to antidepressants or anxiety medication) or mental health specialists, it is important to frame this as similar to what any person may require during their lives, and not automatically associate 2STIGD people’s mental health needs with gender diversity.