Barriers to Mental Health Care Access for Transgender Youth

Author’s Note: 

I decided to write about this topic because of the worsening prejudice and discrimination against transgender people at this moment in history. Many of my transgender loved ones have struggled to receive adequate mental health care or any care at all. I knew there must be data on the mechanisms behind this discrepancy, so I decided to conduct a review on the current body of work. I initially wrote this paper for UWP 102H: Writing in Human Development and Psychology, and was encouraged by my professor to share it. I hope to communicate that there are tangible things that can be improved on to save transgender lives and that these changes are not only necessary, but possible. 

Barriers to Access: 

Transgender and gender-diverse people are individuals whose gender does not match their sex assigned at birth. Unfortunately, this population is much more likely to experience anxiety, depression, self-harm, and suicidal ideation (Lucas et al., 2024; Colvin et al., 2019). These discrepancies are explained by many compounding factors, including gender-based discrimination, social rejection, internalized transphobia, economic marginalization, and other systemic inequities (Lucas et al., 2024). Another significant factor is gender dysphoria, which is “distress resulting from an incongruence between one’s gender identity and sex assigned at birth,” which can be especially severe during adolescence (Lucas et al., 2024, p. 268). Changes in puberty, such as hair growth and the development of secondary sex characteristics, make these internal incongruities more visible. Transgender youth have been found to have heightened rates of both anxiety and depression, more frequent experiences with violence, chronic sadness, and hopelessness, as well as higher rates of substance use and lower rates of feeling safe at school (Lucas et al., 2024). Interviews with parents of transgender youth about their experiences of receiving gender-affirming care confirm that quality care is indeed lifesaving (Kidd et al., 2023), a testament shared by their children. Despite reporting a higher need for mental health support, transgender people are less likely to seek out care due to previous negative experiences, stigma, and fear surrounding treatment (Colvin et al., 2019). These compounding factors suggest that special attention should be paid to transgender youths' experiences with mental health and related services in order to foster resilience and well-being. 

There is limited research on transgender mental health, though the literature is growing, with most research being done with adults in small convenience samples (Lucas et al., 2024). The research conducted with youth has focused on identifying buffering factors, locating barriers to mental health care access, and finding common routes that transgender people can use to find services. Several findings have been located in these areas, providing a strong foundation for guiding high-quality transgender care practices and policies. Individual practitioners and clinics can benefit from recommendations on how to improve accessibility that are supported by data. Families can gather reputable resources for supporting their youth and compile information on how to best navigate the system. Insurance policymakers, licensing boards, and leaders in health care systems need evidence-based suggestions to write equitable policy. The progress made in each of these avenues can greatly improve outcomes for transgender youth. 

Parental support mediates all other factors as parents must legally sign off on any gender-affirming care that their child receives in almost all U.S. states (Kidd et al., 2023). Thus, familial support is essential beyond the benefits of social support in and of itself. Social support, whether from family, peers, or partners, has been linked to lower levels of anxiety and depression among gender-diverse adolescents (Lucas et al., 2024). School support has also been identified as a buffering factor, as transgender youth generally report lower levels of school connectedness and are significantly less likely to reach out to teachers and adults from school for support compared to cisgender students (Lucas et al., 2024). While social support is essential, there are other structural barriers to care that must be addressed. 

Discussion 

Though data is limited, several critical findings related to transgender care have been identified. Parents and peers should aim to foster supportive and gender-affirming environments (Lucas et al., 2024). Schools should implement a curriculum that addresses transgender history, train all staff in LGBT+ competency, and ensure access to gender-aligning spaces (Lucas et., 2024). Practitioners and clinics should ensure competency in treating transgender youth by implementing training on gender-affirming care in order to increase effectiveness of treatment (Lucas et al., 2024; Kidd et al., 2023). Providers should also make a practice of asking clients for their preferred name and pronouns, seek ongoing education about gender-diverse youth, and compile accessible resources (Kidd et al., 2023). Access to mental health care can become more equitable by allowing self-referral as a universal option, as transgender people are more likely to utilize this option (Colvin et al., 2019). Transgender people often must travel further to access gender-affirming practitioners, as people trained in this kind of care are few and far between. However, telehealth services have been shown to increase access by reducing financial stress and travel burden on transgender people; these services should be available as an option universally, and insurance should cover them (McGregor et al., 2023). The low frequency of providers with competence in gender-affirming care makes access difficult, especially for those in rural areas. As such, insurance denials based on location are inequitable due to the rarity of competent providers (McGregor et al., 2023; Kidd et al., 2023). Licensing boards need to develop policy for licensing reciprocity across state lines, as locating providers competent in gender-affirming care can be very difficult, and they may not be available locally (McGregor et al., 2023). In identifying ways that transgender youth commonly access services, as well as unique difficulties they may face, equitable infrastructure can be built and barriers can be removed. 

Research on barriers to mental health access for transgender youth is limited yet ongoing. Further research should examine common pathways to large-scale access and should interview both youths and their parents on what aspects of their experiences need attention. Additionally, designing a small-scale, multipronged intervention would provide invaluable insights into supporting the transgender youth population as a whole. Suggestions for this work include education for parents and teachers, as these adults make up a large part of children's support systems. Peer support groups should be implemented by clinicians trained in gender-affirming care, which can be made accessible by having both remote or in-person options. School counselors should be trained in gender-affirming practice, because transgender youth report being more likely to talk to counselors than other adults at school (Lucas et al., 2024). In tandem, these three approaches would be expected to increase levels of social support and would, in turn, increase mental health and well being for transgender youth. 

References

Colvin, E. G. H., Tobon, J. I., Jeffs, L., & Veltman, A. (2019). Transgender clients at a youth 

mental health care clinic: Transcending barriers to access. Canadian Journal of Human Sexuality, 28(3), 272-276. https://doi.org/10.3138/cjhs.2018-0004

Lucas, R., Geierstanger, S., & Soleimanpour, S. (2024). Mental health needs, barriers, and 

receipt of care among transgender and nonbinary adolescents. Journal of Adolescent Health, 75(2), 267-274. https://doi.org/10.1016/j.jadohealth.2024.03.009 

McGregor, K., Williams, C. R., Botta, A., Mandel, F., & Gentile, J. (2023). Providing essential 

gender-affirming telehealth services to transgender youth during COVID-19: A service review. Journal of Telemedicine and Telecare, 29(2), 147-152. https://doi.org/10.1177/1357633X221095785 

Kidd, K. M., Sequeira, G. M., Katz-Wise, S., Fechter-Leggett, M., Gandy, M., Herring, N., 

Miller, E., & Dowshen, N. L. (2023). “Difficult to find, stressful to navigate”: Parents' experiences accessing affirming care for gender-diverse youth. LGBT Health, 10(7), 496-504. https://doi.org/10.1089/lgbt.2021.0468 

Author's Bio

Sophia Marentette is a fourth-year psychology student who will be graduating in Spring 2026. They are interested in relationship science, personality, gender diversity, and sexuality as subjects of research and hope to explore these topics in graduate school. Sophia currently works in a lab at UC Davis studying polyamorous relationship structures and presented this research at the 2026 Social and Personality Psychology Annual Conference. They have also presented their independent original research at the Bay Area Honors Symposium at Stanford.