Affirming. Educating. Creating Hope and Healing Lives

Depression and Transgender Issues

Transgender people do not necessarily experience depression; however, transgender people experience the kinds of stress that could, along with other factors, lead to depression. Factors such as genetic predisposition, multiple stressors, psychological vulnerability, and a lack of social support can all contribute to depression.

Gender Dysphoria does not necessarily lead to clinical depression; however, my experience is that transgender people who are highly conflicted about how to resolve their gender feelings, who have not been able to put a plan in place to relieve their gender dysphoria, or who have experienced losses, stigmatization, and discrimination during gender transition are at a greater risk of becoming depressed then the average person.

The complex problems associated with gender transition, coming out, fears and anxiety, and uncertainty about the future all place a tremendous strain on a person's coping ability. When problems such as social intolerance, discrimination, under-employment and unemployment, and rejection by loved ones occur, coping skills can be overwhelmed. Social support from a transgender support group and friends and family can help to prevent an emotional collapse; however, transgender persons can somtimes have difficulty reaching out for help or isolate themselves from potential sources of support. The result can be loneliness, depression, alcohol and drug abuse. Suicidal thinking can occur when the emotional suffering is intolerable, when the suffering and the problems do not seem to have any resolution, and the person feels hopeless about the future. Suicide risk is often greater when suicide is viewed in a positive light, and when the person does not believe there are any significant reasons to continue living.

What are the symptoms of depression?

Depression is a disorder of mood where one feels sadness or irritability, a loss of interest and pleasure in activities in life, a loss of energy, and disturbed sleep. Symptoms last for at least two weeks more days than not, and cause some degree of disturbance in normal ability to function.  Additional symptoms often include:

  • feeling tired and lethargic

  • poor attention and concentration

  • inability to sleep normally or sleeping too much of the time

  • a loss of appetite or eating more than normal

  • hopelessness

  • negative self-esteem

  • loss of sexual libido

  • thoughts of death or suicide

How do I know if I am depressed?

If you have 4 or more of the above symptoms for two weeks or more, and this cluster of symptoms is disturbing your ability to function to some degree, then you may have a depression that needs treatment. Do not assume that depression is a normal reaction to gender dysphoria or gender transition. However, the stress and losses that may be experienced along with gender conflicts and gender transition places you at a higher risk for developing depression. Depression should be targeted for treatment in addition to any counseling you may be receiving for gender identity issues. There is no medical test for depression. Depression can usually be easily diagnosed by an experienced psychotherapist, psychologist, or physician.

Download a commonly used screening measure for Depression
HERE. Additional information about this screening measure for depression can be found below along with information about how to understand your screening score.

Caution: This is a screening measure for depression only and will not confirm whether or not you have a clinical depression. Only a licensed mental health professional or a physician can diagnose depression.

PHQ9 Personal Health Questionnaire - Depression

The PHQ-9: Validity of a Brief Depression Severity Measure
Kurt Kroenke, MD, Robert L Spitzer, MD, and Janet B W Williams, DSW

Download the PHQ9 here:


For initial diagnosis:
1. Complete the PHQ9 and discuss it with your physician or a mental health professional.
2. If there are at least 4 checks in the blue highlighted section (including Questions #1 and #2), consider a depressive disorder. Add score to determine severity.
3. Consider Major Depressive Disorder if there are at least 5 checks in the blue highlighted section (one of which corresponds to Question #1 or #2)
4. Consider Other Depressive Disorder, if there are 2 to 4 checks in the blue highlighted section (one of which corresponds to Question #1 or #2)

Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician and a definitive diagnosis made on clinical grounds, taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient. Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of social, occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms.

To monitor severity over time for newly diagnosed patients
or patients in current treatment for depression:

1. Patients may complete questionnaires at baseline and at regular intervals (eg, every 2 weeks) at home and bring them in at their next appointment for scoring or they may complete the questionnaire during each scheduled appointment.
2. Add up numbers by column. Several days = 1 More than half the days = 2 Nearly every day = 3
3. Add together column scores to get a TOTAL score.
4. Refer to Interpretation of Total Score.
5. Results may assist in setting up a treatment goal, determining response to treatment, as well as guiding treatment intervention.

For Healthcare Professional Use Only

Scoring—add up all checked boxes on PHQ-9
For every check: Not at all = 0; Several days = 1; More than half the days = 2; Nearly every day = 3

Interpretation of Total Score
Total Score Depression Severity
1-4 Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression