Gender identity change and depression
Gender Identity Change and Mental Health Among U.S. Youth
André Gonzales Real, Maria Inês Rodrigues Lobato, and Stephen T. Russell
Gender identity refers to how a person understands their gender internally, or whether they see themselves as a man, a woman, or something else. Transgender and gender diverse (TGD) people are those whose gender identity is different from their sex assigned at birth or from traditional expectations of gender. Gender identity development is a complex and dynamic process, particularly during adolescence, which is a period marked by important changes – psychological, emotional, and social.
While a growing body of research has highlighted the needs and experiences of sexual and gender minority (SGM) youth, questions remain about how gender identity evolves over time and how these changes are associated with mental health.
This brief summarizes a recent study [1] in which the authors investigated whether and how often gender identity changed over time among SGM youth aged 15 to 21. They also explored the implications of any changes in gender identity on mental health as well as the role that victimization related to being lesbian, gay, bisexual, transgender, or queer played in shaping mental health.
Key Findings
- Nearly one in five (18.3%) sexual and gender minority (SGM) youth reported changes in their gender over a 3.5-year period.
- Four distinct patterns of gender identity change were identified:
- Consistently cisgender (gender identity matches sex assigned at birth)
- Consistently transgender or gender diverse (TGD)
- Changed from cisgender to TGD
- Changed from TGD to cisgender
- Youth who changed from cisgender to TGD identities had higher levels of depression compared to the other groups (see figure). However, this relationship was explained by their higher levels of exposure to LGBTQ victimization.
- Changes in gender identity over time were not linked to changes in depressive symptoms (see figure), suggesting that gender identity identify exploration is a normal aspect of adolescent development.
Nearly one in five SGM youth reported changes in their gender identity over time.
The study found that over 18% of participants reported a change in their self-identified gender across four waves of data collection spanning 3.5 years. This finding suggests that although gender identity is fixed for most youth, gender identity development is a fluid and evolving process for many, not restricted to childhood.
Four distinct patterns of gender identity change were identified.
The researchers categorized youth into four groups based on how their gender identity changed—or did not change—over time: those who were consistently cisgender, consistently transgender or gender diverse (TGD), those who transitioned from cisgender to TGD, and those who transitioned from TGD to cisgender. This classification allowed for a more nuanced understanding of the diversity of gender identity experiences.
Youth who changed from cisgender to TGD identities had higher depressive symptoms at the beginning of the study.
Adolescents who changed from a cisgender to a TGD identity had higher levels of depressive symptoms at the start of the study (see figure). Not only was this group exposed to more LGBTQ victimization, but exposure to victimization also explained the differences in depressive symptoms between groups This group was also more likely to report exposure to LGBTQ victimization. These findings suggest that gender transitions are not inherently distressing, but rather the stress of navigating a minority identity in a hostile environment may contribute to depressive symptoms.
Gender identity fluidity was not associated with changes in depressive symptoms.
Changes in gender identity across the study period did not predict increases or decreases in depressive symptoms. In fact, young people who reported the most change in their gender identities had among the lowest levels of depression over time. This suggests that gender identity exploration, in and of itself, is not detrimental to mental health. Instead, the presence—or absence—of support systems and protection from violence play a greater role in shaping youth mental health.
Policy Implications
These findings have important implications for policies aimed at supporting the health and well-being of SGM youth. The evidence underscores that gender identity exploration is a common and developmentally appropriate aspect of adolescence. Policies and educational practices should reflect this by promoting affirming, inclusive environments where youth feel safe to express their identities without stigma or punishment. Schools, healthcare providers, and community organizations should implement training to increase awareness of gender diversity and reduce bias among staff and service providers.
Mental health support must also be responsive to the challenges faced by youth transitioning to TGD identities, particularly those who experience LGBTQ victimization. Targeted mental health services, including trauma-informed care and culturally competent counseling, are essential for counteracting the effects of discrimination and rejection. Additionally, anti-bullying laws and non-discrimination policies should be strengthened and rigorously enforced to protect SGM youth in schools and public spaces.
Data and Methods
The researchers analyzed four waves of data from 366 SGM youth aged 15 to 21. Participants, who were recruited from community-based agencies and college groups for SGM young people in two U.S. cities, took surveys every nine months over 3.5 years between 2012 and 2015. Gender identity was assessed at each wave of data. Depressive symptoms were measured using the Beck Depression Inventory for Youth (BDI-Y). The researchers used hierarchical linear models to investigate associations between gender identity trajectories and depressive symptoms over time.
Reference
[1] Real, A.G, Lobato, M.I.R., & Russell, S.T. (2024). Trajectories of gender identity and depressive symptoms in youths. JAMA Network Open 7(5):e2411322. https://doi.org/10.1001/jamanetworkopen.2024.11322
Suggested Citation
Real, A.G, Lobato, M.I.R., & Russell, S.T. (2025). Gender identity change and mental health among U.S. youth. PRC Research Brief 10(3). https://doi.org/10.26153/tsw/60545
About the Authors
André Gonzales Real (andregreal@utexas.edu) recently received his PhD in Human Development and Family Sciences at The University of Texas at Austin and is an incoming assistant professor and academic psychiatrist in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, Ontario, Canada; Maria Inês Rodrigues Lobato is a medical doctor in the Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; and Stephen T. Russell is director of the School of Human Ecology, professor in the Department of Human Development and Family Sciences, Amy Johnson McLaughlin Administrative Chair in Human Ecology, Priscilla Pond Flawn Regents Professorship in Child Development, and faculty scholar at the Population Research Center at The University of Texas at Austin.
Acknowledgements
This study was supported by the National Institutes of Mental Health (grant No. R01MH091212). This research brief was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849), awarded to the Population Research Center at The University of Texas at Austin. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Mental Health or the National Institutes of Health.