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The role of gender affirmation and gender euphoria in mental health and suicidality among trans and gender diverse people in Australia

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Key findings Background Medical and legal gender affirmation among trans and gender diverse adults Social, medical and legal gender affirmation among trans and gender diverse young people Gender euphoria among trans and gender diverse adults

If at any point you feel worried about harming yourself while viewing this information – or if you think someone else may be in danger – please stop reading and seek help. You can access LGBTIQ+ resources online, and QLife (trained LGBTIQ+ peer support): Telephone 1800 184 527 (3:00pm - midnight everyday 7 days a week) or by webchat.

The acronym LGBTIQ+ is used as an umbrella term to refer to lesbian, gay, bisexual, trans/transgender, intersex, queer and other sexuality, gender and bodily diverse people and communities.

The data presented on this page are from the 2019 Private Lives 3 (PL3) and Writing Themselves In 4 (WTI4) surveys. While these surveys included participants with an intersex variation/s, the data could not be disaggregated by this category and, therefore, the acronyms LGBTQ+ or LGBTQA+ are used when referring to the results.

For more information on terminology relating to LGBTIQ+ people and communities, see the Australian Institute of Family Studies’ (AIFS) LGBTIQA+ glossary of common terms (AIFS 2022).

Key findings

  • Easy access to gender affirming care was associated with lower psychological distress and suicidal thoughts, and greater gender euphoria among trans and gender diverse adults.
  • Legal affirmation of gender (such as changing a driving licence or birth certificate) was linked to lower psychological distress among trans and gender diverse adults, and fewer suicidal thoughts among trans and gender diverse young people.
  • Gender euphoria was more common among trans and gender diverse adults who felt connected to the LGBTIQ community or with access to gender affirming care and was associated with lower psychological distress and suicidal thoughts.

Background

In 2023, AIHW funded a project by the Australian Research Centre in Sex, Health, and Society at La Trobe University to undertake secondary analysis of the Private Lives 3 (PL3) and Writing Themselves In 4 (WTI4) surveys of LGBTQ+ adults and LGBTQA+ young people, respectively, in Australia. The aim of the project was to investigate in more detail the experience of LGBTQ+ people in relation to suicidal thoughts and behaviour, mental health and alcohol and other drugs. A series of papers from this research have been published. Highlights of three of these papers, which focussed specifically on transgender (trans) and gender diverse people and the relationship between gender affirmation, gender euphoria and mental health and suicidality are displayed below. The dimensions of gender affirmation investigated included: legal (updating a birth certificate or driver licence); social (presenting to friends and family in your affirmed gender); and medical (hormone therapy or surgery).

Medical and legal gender affirmation among trans and gender diverse adults – associations with gender euphoria, mental health and suicidality

This study included 1,359 trans and gender diverse adults from the PL3 survey. Among this sample (Grant et al. 2024c):

  • More than three-fifths (63%) reported feeling that they would not be able to easily access gender affirming care when needed.
  • Around half (51%) had accessed hormone therapies at some point in their lives.
  • Around half (51%) had legally affirmed their gender. 
  • Less than one-quarter (22%) reported currently experiencing gender euphoria, while nearly one-third (31%) reported never having experienced gender euphoria.

Looking at trans men, trans women and gender diverse study participants separately, the findings show that (Grant et al. 2024c) (Figure 1a): 

  • Half of the trans men (50%) and trans women (50%) reported being ‘easily able to access gender affirming care when needed’, compared with around a quarter (26%) of the gender diverse participants.
  • Trans men and trans women were also more likely to report easy access to any legal affirmation (65% and 77%, respectively), compared with gender diverse participants (29%).
  • Over a quarter (27% and 28%, respectively) of the trans men and trans women reported currently experiencing gender euphoria, greater proportions than the gender diverse participants (15%).

The study used logistic regression models to investigate the relationship between gender affirmation factors and suicidal thoughts, attempts, psychological distress and gender euphoria. The results of these analyses (presented as adjusted odds ratios (AOR) with confidence intervals (CI)) show that (Grant et al. 2024c) (Figure 1b):

  • Participants who reported being ‘easily able to access gender affirming care when needed’ were less likely to experience suicidal thoughts in the past 12 months (AOR = 0.73 95% CI: 0.55 to 0.96) and psychological distress in the past 4 weeks (AOR = 0.60 95% CI: 0.44 to 0.83), and were more likely to have experienced gender euphoria in their lifetimes (AOR = 1.89 95% CI: 1.38 to 2.59), compared with those who had not been able to easily access gender affirming care when needed.
  • Those who had any legal affirmation of their gender were less likely to report psychological distress in the past 4 weeks than those who had no legal affirmation of their gender (AOR = 0.58 95% CI 0.39 to 0.86).

Figure 1a and 1b: Medical and legal gender affirmation: Associations with mental health, suicidality and gender euphoria among trans and gender diverse people

The visualisation includes 2 static charts, Figure 1a and Figure 1b. Figure 1a is a bar chart showing the percentage of trans men, trans women and gender diverse people in the study who reported being able to easily access gender affirming care when needed, using hormone therapy, having any legal gender affirmation, and having experienced gender euphoria. Figure 1b includes 4 forest plots showing the adjusted odds ratios for 1. suicidal thoughts in the past 12 months, 2. suicide attempt in the past 12 months, 3. psychological distress in the past 4 weeks and 4. gender euphoria in the lifetime for those who were easily able to access gender firming care (compared with those who could not), using hormone therapy or planning to (compared with those who had not and had no plans to) and having had legal gender affirmation (compared with those who had not).

The visualisation includes 2 static charts, Figure 1a and Figure 1b. Figure 1a is a bar chart showing the percentage of trans men, trans women and gender diverse people in the study who reported being able to easily access gender affirming care when needed, using hormone therapy, having any legal gender affirmation, and having experienced gender euphoria. Figure 1b includes 4 forest plots showing the adjusted odds ratios for 1. suicidal thoughts in the past 12 months, 2. suicide attempt in the past 12 months, 3. psychological distress in the past 4 weeks and 4. gender euphoria in the lifetime for those who were easily able to access gender firming care (compared with those who could not), using hormone therapy or planning to (compared with those who had not and had no plans to) and having had legal gender affirmation (compared with those who had not).

Social, medical and legal gender affirmation among trans and gender diverse young people – associations with suicidal thoughts, attempts and self-harm

This study included 1697 14-to-21-year-old trans and gender diverse young people from the WTI4 study. Among these participants (Grant et al. 2024b) (Figure 2a):

  • Almost all (98%) reported having wanted to socially affirm their gender at some point in their lives, while under three-quarters (72%) had wanted to affirm it medically and three-quarters (75%) had wanted to affirm it legally. 
  • Nearly three-quarters (74%) had actively affirmed their gender socially, while substantially lower proportions had affirmed their gender medically (22%) or legally (17%).

The study used logistic regression models to investigate the relationship between gender affirmation factors and suicidal thoughts, attempts and self-harm. The results of these analyses (presented as adjusted odds ratios (AOR) with confidence intervals (CI)) show that (Grant et al. 2024b) (Figure 2b):

  • Young trans and gender diverse people who had legally affirmed their gender were less likely to report suicidal thoughts in the past 12 months (AOR = 0.59; 95% CI: 0.39–0.89), compared with those whose gender had not been legally affirmed (Grant et al., 2024b).

Figure 2a and 2b: Gender affirmation among trans and gender diverse youth and associations with suicidal thoughts, attempts and self-harm

The visualisation includes 2 static charts, Figure 2a and Figure 2b. Figure 2a is a bar chart showing the percentage of trans men, trans women and gender diverse people in the study who hoped to or were actively affirming their gender. Figure 2b includes 3 forest plots showing the adjusted odds ratios for 1. suicidal thoughts in the past 12 months, 2. suicide attempt in the past 12 months and 3. self-harm in the past 12 months for those who had affirmed their gender medically (compared with those who had not), affirmed their gender legally (compared with those who had not) and affirmed their gender socially (compared with those who had not).

The visualisation includes 2 static charts, Figure 2a and Figure 2b. Figure 2a is a bar chart showing the percentage of trans men, trans women and gender diverse people in the study who hoped to or were actively affirming their gender. Figure 2b includes 3 forest plots showing the adjusted odds ratios for 1. suicidal thoughts in the past 12 months, 2. suicide attempt in the past 12 months and 3. self-harm in the past 12 months for those who had affirmed their gender medically (compared with those who had not), affirmed their gender legally (compared with those who had not) and affirmed their gender socially (compared with those who had not).

Gender euphoria among trans and gender diverse adults – influencing factors and associations with mental health

This study explores factors associated with having experienced gender euphoria and the relationship between gender euphoria and suicidal thoughts, behaviour and psychological distress among a sample of 1359 trans and gender diverse adults from the PL3 survey. As in the previous two studies, regression models were used in the analysis and the results are presented as adjusted odds ratios (AOR) with confidence intervals (CI).  Findings show that (Grant et al. 2024a):

  • Trans and gender diverse people who reported feeling part of the Australian LGBTIQ community (AOR = 1.59 95% CI 1.20 to 2.12) or that they had been easily able to access gender affirming care when needed (AOR = 1.83 95% CI 1.33 to 2.51) were more likely to have experienced gender euphoria in their lifetimes (Figure 3a)
  • Compared with those not experiencing gender euphoria, trans and gender diverse people who reported experiencing gender euphoria at the time of the survey were (Figure 3b):
    • less likely to report having suicidal thoughts in the past 12 months (AOD = 0.61 95% CI 0.44 to 0.86) 
    • less likely to have experienced high/very high psychological distress in the past 4 weeks (AOR = 0.42 95% CI 0.29 to 0.61).

Figure 3a and 3b: Gender euphoria: Influencing factors and mental health associations

The visualisation includes 2 static charts, Figure 3a and Figure 3b. Figure 3a is forest plot showing adjusted odds ratios for factors associated with experiencing gender euphoria, including sexual orientation, gender, age, income, education, residential location, feeling part of the LGBTQ community and being easily able to access gender affirming care. Figure 3b includes 3 forest plots showing the adjusted odds ratios for 1. suicidal thoughts in the past 12 months, 2. suicide attempt in the past 12 months and 3. experiencing high or very high psychological distress in the past 4 weeks, for those who experienced gender euphoria in the past and those currently experiencing gender euphoria (compared with those who had never experienced gender euphoria).

The visualisation includes 2 static charts, Figure 3a and Figure 3b. Figure 3a is forest plot showing adjusted odds ratios for factors associated with experiencing gender euphoria, including sexual orientation, gender, age, income, education, residential location, feeling part of the LGBTQ community and being easily able to access gender affirming care. Figure 3b includes 3 forest plots showing the adjusted odds ratios for 1. suicidal thoughts in the past 12 months, 2. suicide attempt in the past 12 months and 3. experiencing high or very high psychological distress in the past 4 weeks, for those who experienced gender euphoria in the past and those currently experiencing gender euphoria (compared with those who had never experienced gender euphoria).

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