Transgender, Genderqueer, and Mental Health

We need to better understand what is most important for transgender youth.

Posted Dec 25, 2017

By ParaDox(Wikimedia Commons)
Source: By ParaDox(Wikimedia Commons)

Jesse Singal, a behavioral science journalist who frequently writes about gender, sex, politics, and social science research, has been raising important issues concerning transgender youth. Singal’s conclusion is clear and forms the basis of this post: Gender dysphoria during childhood and adolescence is “complicated and deserves a nuanced public conversation.” This means hard questions must be asked, even if they evoke sensitive disagreements.

Today, I touch on one of these “difficult” transgender questions: Which is of greater importance, sex or gender? More specifically, what happens to youths who feel that the sex they were assigned at birth might not match the gender they feel inside and thus do not consider themselves trans men or trans women, but trans nevertheless?

Usually, we label such youths transgender and may or may not include them in our trans-oriented research. But are they transgender or genderqueer? Genderqueer is “a person who feels that his/her gender identity does not fit into the socially constructed ‘norms’ associated with his/her biological sex.” Sounds like transgender, right? Sounds like some sexual minorities, right? Sounds like some straight youths, right? However, the elaboration of genderqueer knocks these out of contention because the definition also states that a “genderqueer is not transgendered, though the option is open to transition. Being genderqueer has no bearing on sexual identity or orientation.”

Why am I confusing you? One of the most important issues, for lots of reasons, explored by researchers is the mental health of LGBTQ youths—which includes sexual-minority, transgender, and genderqueer youth. Note that I reserve judgment in this post about whether these youths should be combined as if they were one population; I’m letting it slide this time. Rather, I’m focusing on what I consider to be the most critical factor in research conducted on sexual- and gender-minority youth—who should be included in the target population? Many experts strongly disagree.

Two Studies

Let’s look at two different studies that explored transgender individuals. Pflum and colleagues surveyed individuals who identified themselves as “transgender or gender nonconforming,” and were placed into one of two groups (I’m omitting intersex here):

1. Those who identified as woman, trans woman, or genderqueer assigned female at birth (trans female spectrum). Thus, all individuals are oriented toward a female gender, but some individuals were born male (woman, trans woman) and others were born female (genderqueer).

2. Those who identified as man, trans man, or genderqueer assigned male at birth (trans male spectrum). Thus, all individuals are oriented toward a male gender, but some individuals were born female (man, trans man) and others were born male (genderqueer).

Because it does not appear from the results that the two groups varied from each other in mental health, are we to conclude that neither sex nor gender was more responsible for influencing mental health? Or, because neither gender nor sex was held constant in each group did this result in any effect of sex or gender to be masked, or did they cancel each other out, or was “something else” operating?

This leads us to a second study, by Veale and colleagues, who had a different methodology and definitions:

“When a person’s sex and gender do not match, they might think of themselves as transgender. Sex is what a person is born. Gender is how a person feels. Which one response best describes you?:

  • “I am transgender and identify as a boy or man.”
  • “I am transgender and identify as a girl or woman.”
  • “I am transgender and identify in some other way.”

Participants in this third group were labeled nonbinary because they didn’t identify as either sex; what they did identify as, other than transgender, is not clear but they appear to be genderqueer.

The inclusion of this third, genderqueer, group is an important feature, though it bears noting that over 40% of the sample was in this group—not trans man or trans woman but trans nonbinary (genderqueer). This is not an insignificant number. It is only in the Discussion section of the paper do we learn that “most” of these youths were assigned “female” at birth. This is consistent with the Pflum paper: Most genderqueer youth are born female but feel that their gender identity/expression “belongs” to neither the female nor the male sex.

What is important here is that nonbinary (genderqueer) individuals were the most problematic in that they reported lower levels of overall mental health and higher incidence of self-harm in the past year than the trans men and trans women.

My Question: Why?

Is this the subgroup of trans youth that is driving the exceptionally poor mental health statistics of the transgender population? If so—and I cannot really tell—then the explanation given by Veale as to why nonbinary youths were so disturbed is noteworthy:  

     “Put another way, there may added difficulties in having a nonbinary gender identity in a very binary world, which leads to greater psychological distress. This group is likely to be less understood and acknowledged than transgender youth whose gender identity fits into the man/woman binary, and this may mean nonbinary youth are less likely to have social support.”

That is, because they don’t place themselves into society’s recognized binary of either male or female, they suffer, in particular, according to Veale, because they have less support from the environment. The authors assume one reason for mental health deficiencies is the world not liking nonbinary youth, those who dare not be obviously male or female.

This may be true, but consider other options, ones that turn this cause/effect argument in the opposite direction. Maybe we should ask: Why did these females at birth not “pick” a sex while other trans individuals, also born female, did? Was there something different about them prior to not selecting a sex? Whatever this reason, might it have added to their mental health problems? Or, perhaps, they didn’t select a sex because of their pre-existing mental health status or their confusion about their sex? What is the mental health status of genderqueer youth born male and who don’t select a sex? And why is this group so far less prevalent than genderqueer youth born female? Does having a penis rather than a vagina clarify to a child their sex?

Although these are not issues raised by the authors, they could be critical to help us understand why transgender youths have such alarmingly high mental health problems. Their lives might well depend on us asking these types of questions.

References

Pflum, S. R., Testa, R. J., Balsam, K. F., Goldblum, P. B., & Bongar, B. (2015). Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 2, 281-286.

Veale, J. F., Watson, R. J., Peter, T., & Saewyc, E. M. (2017). Mental health disparities among Canadian transgender youth. Journal of Adolescent Health, 60, 44-49.

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