This piece discusses suicidal thoughts and behaviors. If you or someone you know is struggling, the 988 Suicide & Crisis Lifeline (call or text 988) is available, along with Befrienders Worldwide for international support.
In the college health clinic where I work, my top concern for young transgender patients is suicide — and the statistics back that up: 98% of transgender people who’ve experienced repeated discrimination have thought about suicide, 51% have attempted it, and only 44% of LGBTQ youth wanting mental health care can access it.
This isn’t inevitable — it’s downstream of a hostile political and social environment. The minority stress model explains why: external stress like bullying and discriminatory laws feeds internal stress like internalized shame, which drives depression and suicidality. You can’t work on self-actualization when basic safety isn’t met.
I think of a patient I’ll call Milo, who grew up isolated, scared to talk to his parents, severely depressed for years without treatment. In college, he found care, community, and safety — and is now on track to graduate. That transformation is only possible when people feel safe, which includes safe healthcare: most transgender patients have had negative experiences in medical settings, often from ignorance rather than malice (wrong forms, wrong pronouns), and each small signal compounds into “it’s not safe here.” Gender-affirming medical care measurably improves mental health outcomes and lowers suicidality — this isn’t up for debate in the evidence. You don’t need to be a clinician to help. Create safety where you can. Advocate for protective policies. Challenge misconceptions. Be willing to change your mind. Witnessing someone move from scared to thriving is powerful — and it happens more often when the people around them show up.