Transphobia

Transgender individuals are at increased risk for experiencing aggression and violence throughout their life when compared to cis (non-transgender) individuals. Even more so when it comes to sexual violence.[25] Aggression and violence against transgender people is perpetrated intentionally through physical violence or bodily harm, sexual violence or assault, and verbal or emotional abuse.[26] Aggression and violence can also include victimization, bullying, harassment, and multiple forms of stigma such as discrimination.[27] Abuse against transgender people can come from many different sources including family, friends, partners, neighbors, co-workers, acquaintances, strangers, and the police.[25] These forms of aggression and violence enacted against transgender people can occur at each developmental stage in life. More so, that one, or multiple kinds of abuse are likely to take place throughout a transgender person's life.[27]

As homophobia and transphobia are correlated, many trans people experience homophobia and heterosexism; this is due to people who associate trans people's gender identity with homosexuality, or because trans people may also have a sexual orientation that is non-heterosexual.[3][28][4] Author Thomas Spijkerboe stated, "Transgender people subjected to violence, in a range of cultural contexts, frequently report that transphobic violence is expressed in homophobic terms."[4] Attacking someone on the basis of a perception of their gender identity rather than a perception of their sexual orientation is known as "trans bashing", analogous to "gay bashing".

According to the American Psychological Association, transgender children are more likely than other children to experience harassment and violence in school, foster care, residential treatment centers, homeless centers and juvenile justice programs.[29] Researchers say trans youth routinely experience taunting, teasing and bullying at school, and that nearly all trans youth say they were verbally or physically harassed in school, particularly during gym class, at school events, or when using single-sex restrooms. Three-quarters report having felt unsafe.[2]

As adults, transgender people are frequently subjected to ridicule, stares, taunting and threats of violence, even when just walking down the street or walking into a store.[21] A U.S. survey of 402 older, employed, high-income transgender people found that 60% reported violence or harassment because of their gender identity. 56% had been harassed or verbally abused, 30% had been assaulted, 17% had had objects thrown at them, 14% had been robbed and 8% had experienced what they characterized as an unjustified arrest.[28]

A study of 81 transgender people in Philadelphia found 30% reported feeling unsafe in public because they were transgender, with 19% feeling uncomfortable for the same reason. When asked if they had ever been forced to have sex, experienced violence in their home, or been physically abused, the majority answered yes to each question.[30]

A review of American studies on sexual violence towards transgender people found that it is "shockingly common" and while reported rates vary considerably among studies for methodological and other reasons, the most common finding is that around 50% of transgender people have been sexually assaulted.[31] In 2009, researcher Rebecca L. Stotzer published an article in Aggression and Violent Behavior that compiled information from numerous studies reporting violence against transgender people.[32] In the article Stotzer noted that transgender people have a high risk of experiencing sexual violence throughout their lifetimes.[32]

Perpetrators of physical violence against transgender people are reported to have been influenced by negative attitudes against transgender people, many of whom do not report their assault to the police.[33] When transgender people are murdered, they are often shot, struck or stabbed repeatedly.[34]

Misgendering is the act of labelling others with a gender that does not match their gender identity.[35] Misgendering can be deliberate or accidental; common examples of misgendering a person are using the wrong pronouns to describe someone,[36][22] calling a person "ma'am" or "sir" in contradiction to the person's gender identity,[37] using a person's previous, pre-transition name for them in place of their current name (a practice called "deadnaming"),[22][38][39] or insisting that a person must adhere to the roles or norms assigned to their sex assigned at birth rather than the ones that align with their gender identity; for example, using a bathroom designated for males even though the person identifies as female.[40]

The experience of being misgendered is common for all transgender people before they transition, and for many afterwards as well.[41] Transgender people are regularly misgendered by doctors,[29] police, media and peers, experiences that have been described as "mortifying",[42] hurtful, cruel,[43] and "only making our lives harder".[44] A 2018 study of 129 transgender and other gender-expansive youth,[45] published in the Journal of Adolescent Health, found that "for each additional social context in which a youth's chosen name was used, there was a statistically significant decrease in depressive symptoms, suicidal ideation, and suicidal behaviors."[46] Deliberately misgendering a transgender person is considered extremely offensive by transgender individuals.[47][43]

A study of 81 transgender people in Philadelphia found 14% said they had been refused routine medical care because they were transgender. 18% answered 'yes' when asked if, when they went in for a check-up, "being transgender created a problem" for them.[30]

Transgender people depend largely on the medical profession to receive not only hormone replacement therapy, but also vital care. In one case, Robert Eads died of ovarian cancer after being refused treatment by more than two dozen doctors.[48] In the United States–based National Center For Transgender Equality's 2011 survey, 19% had been refused medical care due to their transgender or gender non-conforming status,[49] showing that refusal of treatment due to transphobia is not uncommon. Another example of this is the case of Tyra Hunter. Hunter was involved in an automobile accident, and when rescue workers discovered she was transgender, they backed away and stopped administering treatment. She later died in a hospital.[50]

In many European countries, laws require that any transgender person who wishes to change their legal gender must first be sterilized.[51] Sweden repealed its law in December 2012,[52] and the European Court of Human Rights struck down such laws in 2017.[53]

Transphobia also manifests itself in the workplace. Some transgender people lose their jobs when they begin to transition. A study from Willamette University stated that a transgender person fired for following the recommended course of treatment rarely wins it back through federal or state statutes.[54]

News stories from the San Francisco Chronicle and Associated Press cite a 1999 study by the San Francisco Department of Public Health finding a 70% unemployment rate amongst the city's transgender population. On 18 February 1999, the San Francisco Department of Public Health issued the results of a 1997 survey of 392 trans women and 123 trans men, which found that 40% of those trans women surveyed had earned money from full or part-time employment over the preceding six months. For trans men, the equivalent statistic was 81%. The survey also found that 46% of trans women and 57% of trans men reported employment discrimination.[55]

A 2002 American study found that among educators, trans educators are 10–20% more likely to experience workplace harassment than their gay and lesbian colleagues.[2]

In the hiring process, discrimination may be either open or covert, with employers finding other ostensible reasons not to hire a candidate or just not informing prospective employees at all as to why they are not being hired. Additionally, when an employer fires or otherwise discriminates against a transgender employee, it may be a "mixed motive" case, with the employer openly citing obvious wrongdoing, job performance issues or the like (such as excessive tardiness, for example) while keeping silent in regards to transphobia.[56]

Employment discrimination on the basis of gender identity and expression is illegal in the United States. Such discrimination is outlawed by specific legislation in the State of New Jersey and might be in other states (as it is in the states of California, Illinois, Maine, Minnesota, New Mexico and Washington) or city ordinances; additionally, it is covered by case law in some other states. (For example, Massachusetts is covered by cases such as Lie vs. Sky Publishing Co. and Jette vs. Honey Farms.) Several other states and cities prohibit such discrimination in public employment. Sweden and the United Kingdom has also legislated against employment discrimination on the grounds of gender identity. Sometimes, however, employers discriminate against transgender employees in spite of such legal protections.[57]

As an example of a high-profile employment-related court case unfavorable to transgender people, in 2000 the southern U.S. grocery chain Winn-Dixie fired long-time employee Peter Oiler, despite a history of repeatedly earning raises and promotions, after management learned that the married, heterosexual truck driver occasionally cross-dressed off the job. Management argued that this hurt Winn-Dixie's corporate image. The American Civil Liberties Union filed a lawsuit against Winn-Dixie on behalf of Oiler but a judge dismissed it.[58]

Sometimes transgender people facing employment discrimination turn to sex work to survive,[59] placing them at additional risk of such things as encountering troubles with the law, including arrest and criminal prosecution; enduring workplace violence; and possibly contracting sexually transmitted diseases such as HIV.[55]

The transgender community faces huge amount of employment discrimination due to their gender identity, and there are very few laws that protect the employment rights of this community. It results in limited career options for the transgender community leaving them economically vulnerable. A study conducted by Anneliese Singh and Vel McKleroy on transgender people of color revealed that difficulty finding a job or losing a job due to transphobia in workplace resulted in some of the transgender people living in crime-ridden neighborhoods, and getting involved in abusive relationships.[60] Lack of employment has also resulted in the transgender community resorting to illegal activities like selling drugs or sex work for the income support.[61]

Transgender people also face the denial of right of asylum or inhuman treatment in process of asylum-seeking. For example, Fernada Milan, a transgender woman from Guatemala, was placed in an asylum center for males in Denmark, and while there was raped by several men. She was in danger of deportation into Guatemala where transgender people have no rights and face possible execution, but has since been granted entry.[62]

Transgender disenfranchisement is the practice of creating or upholding barriers that keep transgender individuals from voting and therefore restrict the principles of universal suffrage.

Within the school system, many transgender teens are harassed and mistreated with reported negative effects on both victim and the school's population in general.[63] "Transgender youth frequently report fear and anxiety about using restrooms and locker rooms at school because they had experienced harassment by both peers and adults when using them."[64] Over 80% of transgender teens report feeling unsafe in a school environment, more than 40% report having been physically abused, and over 65% report being bullied online or via social media.[63] Through official channels, such discrimination is generally underreported.

A study done on Canadian High School students between December 2007 and June 2009 illustrated how the LGBTQ students feel unsafe at the school, and are exposed to insults and discrimination by their peers and sometimes even by their teachers.[65] Even the heterosexual students and the teachers fear the attack by transphobia on account of supporting or having a transgender friend or family. Most of the administrators and educators are unaware about the extent of damage that has been caused to the transgender students on account of underestimating the gravity of transphobia in their schools.

In North America, organizations associated with the Christian right, including the American Family Association, Family Research Council, Focus on the Family, National Association for Research and Therapy of Homosexuality, believe that "transgenderism" is unnatural and that transgender people are and remain their birth sex. These organizations oppose laws and policies intended to accommodate transgender people, such as allowing them to change their legal sex, use the washroom corresponding to the gender with which they identify, or become ordained Christian ministers. It is their position that God created people's bodies as they are meant to be, that accepting transgender people would violate scripture and natural law, and that the Bible refers to male and female.[66]

According to the Ontario Consultants for Religious Tolerance website, under Pope John Paul II, the Holy See first stated its opposition to reassignment surgery in 2000, although it was not made public until 2003.[67]

Transgender people face particular challenges in attempting to integrate their faith with their gender identity. One author says "expectations [based on gender] are usually predicated upon our genitalia and begin from the moment of birth, continuing throughout our lives."[68] Many Christian denominations use biblical notions of gender and gender roles to support their views. These include "So God created man in His own image, in the image of God He created him; male and female He created them" (Genesis 1:27) and "The woman shall not wear that which pertaineth unto a man, neither shall a man put on a woman's garment: for all that do so are an abomination unto the Lord thy God" (Deuteronomy 22:5).[69]

Views of gender identity based on the Christian faith do not always coincide with the ideologies of transgender individuals. However, if they do not conform to these expectations, they may face rejection. Many transgender Christians seek out an "individualized relationship with God", often facing "a period of denial and struggle" as well as depression, disconnection, dissatisfaction, and spiritual difficulty before "discovering a sense of self that feels integral and true"[70] However, after discovering their gender identity, many transgender individuals still face barriers within the church such as, "fear and unfamiliarity on the part of the congregation, language issues, physical layout that separates people by gender, programs that exclude or separate by gender, pathologizing or designating trans issues as sinful, and overt hostility".[71][69]

The Islamic faith ordinarily supports heteronormative, binary of gender identification. This support is reinforced by the cultural norms of Muslims and their traditional readings of sacred texts which prohibit a wide range of identities.

In 1988, gender reassignment surgery was declared acceptable under Islamic law by scholars at Egypt's Al-Azhar, the world's oldest Islamic university. In Iran during 1987, Ayatollah Khomeini, the supreme religious leader of the Islamic Republic of Iran at that time, also declared transgender surgical operations as acceptable (see transgender rights in Iran). The foundation for this accepting attitude is the belief that a person is born transgender but chooses to be homosexual, thus making homosexuality a sin. Nonetheless, transgender individuals within the Muslim community still face particular challenges.

Some communities of worship are more tolerant—Muslims for Progressive Values has founded Unity Mosques in Atlanta, Georgia; Columbus, Ohio; and Los Angeles, California. The Muslim Alliance for Sexual and Gender Diversity hosts an annual retreat for LGBTQ+ Muslims in Pennsylvania each May.[72]

Protesters outside the 2010 premiere of Ticked-Off Trannies with Knives, written and directed by gay filmmaker Israel Luna, objecting to what they considered to be transphobic portrayals in the film and its trailer, which referred to several notable real-life murders of transgender people before being taken down.[101]

Historian Joanne Meyerowitz documented transphobia within the gay rights movement in the mid 20th century in response to publicity surrounding the transition of Christine Jorgensen. Jorgensen, who made frequent homophobic remarks and insisted she was not connected to or identified with gay men, was a polarizing figure among activists:[102]

In 1953, for example, ONE magazine published a debate among its readers as to whether gay men should denounce Jorgensen. In the opening salvo, the author Jeff Winters accused Jorgensen of a "sweeping disservice" to gay men. "As far as the public knows," Winters wrote, "you were merely another unhappy homosexual who decided to get drastic about it." For Winters, Jorgensen's story simply confirmed the false belief that all men attracted to other men must be basically feminine," which, he said, "they are not." Jorgensen's precedent, he thought, encouraged the "reasoning" that led "to legal limitations upon the homosexual, mandatory injections, psychiatric treatment – and worse." In the not-so-distant past, scientists had experimented with castrating gay men.

Several prominent figures in second wave feminism have also been accused of transphobic attitudes, culminating in 1979 with the publication of The Transsexual Empire by radical lesbian feminist Janice Raymond, who popularized the term shemale as derogatory slur referring to trans women in 1994,[78] and her statements on transsexuality and transsexual people have been criticized by many in the LGBT and feminist communities as extremely transphobic and as constituting hate speech.[103][104][105][106]

In 1950s America, there was a debate among gay men and women about those who felt they were of the opposite sex. Gay men and women who were trying to melt quietly into the majority society criticized them as "freaks" who brought unwanted disreputable attention upon them. Such attitudes were widespread at the time.[107]

Some trans men face rejection from lesbian communities they had been part of prior to transition. Journalist Louise Rafkin writes, "there are those who are feeling curiously uncomfortable standing by as friends morph into men. Sometimes there is a generational flavor to this discomfort; many in the over-40 crowd feel particular unease", stating that this was "shaking the foundation of the lesbian-feminist world".[108] Trans men were part of the protest at the 2000 Michigan Womyn's Music Festival, the first time the 'womyn-born womyn only' policy has been used against trans males, women supporting the transgender community and young gender-variant women.[109]

In the early 1970s, conflicts began to emerge due to different syntheses of lesbian, feminist and transgender political movements, particularly in the United States. San Francisco trans activist and entertainer Beth Elliott became the focus of debate over whether to include transgender lesbians in the movement, and she was eventually blacklisted by her own movement.[110][111]

One view is that the word bisexual is transphobic, as "bi" means "two" (thus implying a belief in the binary view of gender). Some people, such as scholar Shiri Eisner, say that some make the claim that the term "erases nonbinary genders and sexes out of existence",[112] as many dictionaries define bisexuality as "of, relating to, or having a sexual orientation to persons of either sex",[113] "sexually attracted to both men and women"[114] and other similar definitions.[115][116]

However, some bisexual individuals and scholars object to the notion that bisexuality means sexual attraction to only two genders, arguing that since bisexual is not simply about attraction to two sexes and encompasses gender as well, it can include attraction to more than one[117] or more than two genders[118] and is occasionally defined as such.[112] Others, such as the American Institute of Bisexuality, say that the term "is an open and inclusive term for many kinds of people with same-sex and different-sex attractions"[119] and that "the scientific classification bisexual only addresses the physical, biological sex of the people involved, not the gender-presentation."[118]

To deal with issues related to transphobia and the gender binary, some individuals have taken on terms such as pansexual, omnisexual, or polysexual in place of the term bisexual. The American Institute of Bisexuality argues that these terms "describe a person with homosexual and heterosexual attractions, and therefore people with these labels are also bisexual"[119] and that the notion that bisexuality is a reinforcement of a gender binary is a concept that is founded upon "anti-science, anti-Enlightenment philosophy that has ironically found a home within many Queer Studies departments at universities across the Anglophone world".[118] Eisner agrees with this view, stating that "allegations of binarism have little to do with bisexuality's actual attributes or bisexual people's behavior in real life" and that the allegations are an attempt to separate the bisexual and transgender communities politically.[112]

The 2015 United States Transgender Survey, the largest such survey ever carried out (with 27,715 respondents), found that one in ten respondents suffered transphobic violence at the hands of a family member and 8% were kicked out of their homes for being transgender. The majority of those who were openly transgender or perceived as transgender at school were victims of some form of mistreatment on account of this, including verbal abuse (54%), physical attacks (24%), and sexual assault (13%). 17% experienced such severe mistreatment that they had to leave school. Support from one's community or family was correlated with more positive outcomes related to mental health and social functioning.[121]

62% of lawsuits involving transgender people state that defendants face family problems.[122]

Polyvictimization is experiencing multiple forms of abuse and victimization throughout a person's life, such as physical or sexual violence, bullying/aggression, parental neglect or abuse, experiencing crime, etc. Polyvictimization can start in childhood and has consequences for adolescent health and thus adult health.[123][124] Transgender, gender diverse, and sexual minority adolescents (TGSA) are more likely to experience polyvictimization when compared to their cisgender peers.[125] Family traits more associated with polyvictimization in TGSA include: (1) families that have higher than average levels of violence and adversity in their life, (2) families that give their child higher than average levels of microagressions and lower levels of microaffirmations, and (3) families that have average levels of violence and adversity, and also give their child higher levels of microaffirmations. Posttraumatic stress disorder (PTSD) symptoms reported by TGSA has shown to be a significant link between TGSA grouped by their family experiences and polyvictimization.[126]

Posttraumatic stress disorder is considered by the American Psychiatric Association to be an anxiety related disorder that comes from experiencing or witnessing a traumatic event or stressor, such as actual or threatened death, sexual violence, natural disasters, and crime.[127] Research supported by the National Institute of Mental Health (NIMH) assessed lesbian, gay, bisexual, and transgender (LGBT) adolescents and noted that those who had moderate to high, and steady or increasing rates of victimization or verbal or physical threats, were at heightened risk for developing PTSD.[128] Relational and physical bullying victimization, as well as various other forms of emotional distress, are increasingly experienced by the transgender and gender diverse (TGD) adolescent population. Those who experience the most physical and relational bullying victimization and emotional distress, are biologically male youth whom others perceived as very, or mostly feminine. Moreover, regardless of biological sex, relational bullying victimization, depression, and suicidal ideation is common among adolescents that can be perceived as anything other than very, or mostly masculine.[129]

Repeatedly, research on the effects of aggression and violence against TGD youth and young adults shows – when compared to their cisgender peers – higher rates of PTSD, depression, non-suicidal self-injury, suicidal ideation, intent, plan, and attempts, higher rates of substance use (cigarettes, alcohol, marijuana), trauma, skipping school due to safety concerns, and poorer health outcomes.[130][131][132][133][134][135][136][137][138]

In adulthood, the effects of aggression and violence against various groups of transgender people has also been documented in domains such as mental and physical health, and safety and discrimination in the military. Transgender related bias, or discrimination, victimization, and rejection, affects transgender adults and the severity of PTSD symptoms they report. A systematic review completed in 2018 examined 77 studies that reported mental health disparities and social stress felt by TGD adults. The analysis found associations between TGD identity and anxiety, depression, PTSD, substance use, and suicidality, as well as added social stress factors such as violence, discrimination, and exclusion.[139] When examining posttraumatic stress disorder and substance use in transgender adult communities, records indicated that transgender adults who have PTSD are more likely to be diagnosed with a substance use disorder within their lifetime.[140] A National Institute of Health (NIH) analysis conducted with data collected at a community health center in the United States compared transgender and cisgender adult patients on various possible health disparities. Their research showed that within their lifetime, transgender patients experienced more violence, childhood abuse, discrimination, and suicidal thoughts or suicide attempts when compared to their cisgender counterparts who had a similar age, education, ethnicity/race, and income.[141]

Strong associations between military sexual assault (MSA) and PTSD have been documented in both men and women.[142] A nationwide survey of military personnel in 2015 found that 17.2% of transgender veterans reported experiencing MSA, and nearly two times more transgender men (30%) had a MSA experience when compared to transgender women (15.2%). Links have been found between MSA experienced by transgender veterans and increased depression symptom severity, drug use, and PTSD symptom severity.[143]

Posttraumatic stress disorder has also been associated with suicidality and substance use among adults.[144] For instance, records reflect that veterans who identify as transgender increasingly experience PTSD and suicide ideation, plans, and attempts. Further, transgender specific stigma experienced while in the military and PTSD have been associated with deaths by suicide.[145]

This could be worsened by racial health disparities that exist within the Veteran Affairs (VA) Healthcare System.[146] Particularly, racial heath disparities between non-Hispanic Black transgender veterans (BTV) and non-Hispanic White transgender veterans (WTV) have been acknowledged. Non-Hispanic Black transgender veterans are at increased odds of having an array of physical health issues/diseases, serious mental illnesses, alcohol abuse, tobacco use, homelessness, and previous incarceration when compared to the WTV. Non-Hispanic White transgender veterans had increased odds of depression, obesity, and hypercholesterolemia when compared to BTV.[147] Previous incarceration plays a larger role in the PTSD and homelessness that transgender veterans may experience. Specifically, transgender veterans that have a history of previous incarceration are more likely to have PTSD or to experience homelessness when compared to previously incarcerated veterans who are not transgender.[148]

Nearly one third of U.S. transgender people responding to the 2015 U.S. Transgender Survey lived in poverty, compared to 14% of the population. During the 12 months prior to the survey, 30% of employed transgender people were either fired or mistreated for being transgender, from verbal abuse to sexual violence. 30% had been homeless at some point in their life, and 12% had been homeless during the previous year. Family and community support were correlated with significantly lower rates of homelessness and poverty.[121]

During the year prior to the 2015 U.S. survey, 46% of respondents had been verbally harassed and 9% had been physically attacked for being transgender. 10% had been sexually assaulted during the previous year, and 47% had been sexually assaulted at some point in their life.[121]

During the year prior to the 2015 U.S. survey, 12% of respondents reported being verbally harassed in a public restroom. 1% reported being sexually assaulted in a public restroom for being transgender, and 1% reported being otherwise physically assaulted for being transgender. 9% reported being denied the right to use a public restroom consistent with their gender.[121]

During the year prior to the 2015 U.S. survey, 59% of respondents reported avoiding using a public restroom out of fear of violence or harassment. 32% limited the amount they ate or drink in order to avoid using a public restroom. 8% reported suffering a urinary tract infection, kidney infection, or other kidney problem as a result of avoiding public restrooms.[121]

33% reported having negative experiences with a healthcare professional related to being transgender, such as verbal harassment or denial of treatment. 23% reported that they did not seek treatment for a condition out of fear of being mistreated, while 33% did not seek treatment because they were unable to afford it.[121]

During the month prior to the survey, 39% of American transgender people experienced major psychological distress, compared to 5% of the general population of the United States. 40% had attempted suicide at some point in their life, compared to 4.6 percent of the American population. Family and community support were correlated with far lower rates of suicide attempts and of major psychological distress.[121]

A study conducted on transgender women of color in San Francisco has shown a higher correlation between transphobia and risk of transgender women engaging in HIV risk behavior. The study shows that the transgender youth face social discrimination, and they may not have a social role model. The young adults in this group have shown a higher risk of engaging in unprotected receptive anal intercourse when the exposure to transphobia is high. Therefore, as per the study shows a correlation between transphobia and high risk of HIV.[149]

People who are transgender are more likely to experience some type of psychological distress because of the harassment and discrimination that comes with transphobia. Student Affairs Administrators in Higher Education conducted a nationwide survey on college campuses examining the psychological effects on transgender people, with a sample size of 86. Out of these 86 participants, 54% stated they have attended psychological counseling before and 10% had been hospitalized for reasons related to mental health. The final results of the study show that over twice as many participants who considered themselves transgender (43%) had engaged in self-injurious behavior, versus those who considered themselves male or female (16%).[150][151]

According to Virupaksha, Muralidhar, and Ramakrishna, suicide attempts among transgender people globally range from 32% to 50%. In India, 31% to 50% of transgender people have tried to commit suicide before age 20. 50% of transgender people in Australia and 45% of those in England have attempted suicide at least once.[122] In the United States, suicide attempts reported by transgender and gender nonconforming adults exceed the rate of the general population: 41% versus 4.6 percent.[152] In San Francisco alone, the suicide rate among transgender people is 32% overall, and for those under age 25 it is 50%.[122]

According to the study Transphobia Among Transgenders of Color by the University of California, San Francisco, transphobia affects the psychological vulnerability of transgender people of color as compared to those of other ethnicities. Acts of transphobia such as undue denial of services, unfair dismissal from work places or stigmatization have far-reaching effects on the subjects such as low self-esteem, under-performance, stress, withdrawal or even depression. When it comes to the minorities, who are already proven to be undergoing various forms of discrimination, the consequences are even more exaggerated. Transgender people of color are more significantly associated with depression than their white counterparts.[153]

To help transgender people work through traumatic experiences, minority stress, and internalized transphobia, mental health practitioners have begun integrating the gender-affirmative model into cognitive behavioral therapy,[154] person-centered therapy,[155] and acceptance and commitment therapy.[14]