5 tips for finding affirming mental health care as a transgender person

Transgender, gender nonconforming, and nonbinary people are more likely to experience mental health conditions such as anxiety, depression, substance use disorders, and eating disorders than are cisgender people. (Cisgender refers to a person whose gender identity corresponds with the sex they were identified as having at birth.)

This risk of mental health issues is highly influenced by the various types of discrimination members of the transgender community encounter in settings such as housing, employment, education, and the healthcare system. Confronting these daily challenges makes it important for gender-diverse people to have access to affirming mental health care.

Receiving adequate care can significantly improve health outcomes. And with the growing use of telehealth (accessing health care via phone or internet), there are more options than ever for gender-diverse people seeking care.

While it can be daunting to find providers who understand the unique difficulties faced by transgender people, it’s not impossible. Start with these five tips to search for and engage with affirming mental health care providers.

Seek out trusted sources for referrals

One of the challenges that many gender-diverse people face when looking for a mental health provider is finding someone who is affirming and culturally competent. Because the relationship between provider and client is so important for the success of any kind of therapy, it’s important to consider where your referral is coming from.

You might begin by asking your primary care provider for a referral if they’re someone you trust. But this is not your only option. Social media can be another source, including local groups known as “queer exchanges” where LGBTQ+ people exchange resources and recommendations. You can find these on Facebook by searching “[NEARBY CITY] queer exchange.”

You might also seek out your local LGBTQ+ community center or an LGBTQ+ hotline, like those provided by the Trevor Project or Trans Lifeline. Many resources are low-cost or even free.

“There is a mental health fund through the National Queer & Trans Therapists of Color Network,” notes Sand Chang, PhD, a psychologist based in Oakland, California who specializes in working with gender-diverse clients. This fund provides therapy to transgender people of color in need.

“For people who need letters for gender-affirming health care, I encourage people to check out the Gender Affirming Letter Access Project,” Chang adds. “These providers have pledged not to charge for letters.”

Many insurance plans and healthcare providers require that you obtain at least one letter from a mental health provider indicating a diagnosis of “persistent” gender dysphoria in order to transition medically. Gender dysphoria refers to the distress someone might experience when they feel their gender identity doesn’t align with their physical or physiological characteristics. Not all transgender, gender nonconforming, or nonbinary people experience gender dysphoria, but it remains a requirement for obtaining many gender-affirming treatments.

Ask the right questions

Not sure if a provider is transgender-competent? That’s okay. A few basic questions should help you gain some clarity into whether this provider is right for you. These include:

• How long have you been working with gender-diverse clients?
• Do you offer your services on a sliding scale? (This means a therapist may offer pricing that varies based on their patients’ income levels.)
• What sorts of additional LGBTQ-specific education or certifications have you received?
• How confident are you that you can provide care to gender-diverse people?
• How do you plan to educate yourself if you discover a gap in your knowledge?

Access community support

A therapist isn’t your only option for mental health care. Support groups are a great option as well. Your local LGBTQ+ community center is a good way to connect with support groups in your area. In fact, research indicates that a connection to one’s community can improve mental health outcomes and boost a sense of resilience in gender-diverse people.

Don’t hesitate to change providers if you need to

You deserve the best possible fit, which may not be with the first person you contact. If you have a sense that something is not working between you and your therapist, how can you tell when it’s time to move on?

Chang encourages clients to look for certain warning signs.

“Watch if they stumble when they talk to you about gender or pronouns,” Chang says. “And pay attention if they start asking you questions about your gender history, particularly when it’s not relevant to the reason you’re seeking a therapist.”

Other warning signs in therapists include:

• Making assumptions about the types of gender-affirming interventions you’ll be seeking (such as surgeries or name changes)
• Operating within a binary understanding of gender
• Playing “the devil's advocate.” This might include making excuses for people who are not affirming or asking you to consider “how hard it must be for them,” rather than validating your experience.

It could also signal a problem if a therapist asks you to educate them instead of doing that research on their own time. “They should be owning that they have things they might need to learn and be willing to put the work in to do that themselves,” Chang says.

Take advantage of digital resources

If you’re in a remote or rural location, that doesn’t mean you can’t access affirming therapy. Virtual therapy platforms such as telehealth and video conferencing have helped to increase access. Options include BetterHelp and Talkspace. You can also search for online LGBTQ+ therapy.

Many support groups are also available online. While some of these resources may cost you, you can always ask if a sliding scale is available.

Seeking and finding mental health care can take some time and a bit of trial and error, but it is worth the effort. Establishing care with an affirming mental health provider can play a crucial role in improving and sustaining health outcomes for gender-diverse people.