Mason Dunn heard the term “transgender” for the first time when he was a college freshman in the early 2000s. Dunn was assigned female at birth but as a teen struggled with his gender identity.
“So when I came out, there was this moment of finding a term that worked for me that finally captured my struggle with gender and my struggle with gender identity and gender expression.” Dunn said. “It was a really amazing experience. But it was also challenging, in the sense that at that time there was only really a binary understanding of trans identities.”
Finding a therapist as a student at the University of Southern California who could help Dunn navigate his non-binary gender identity was difficult, back when the trans population was less visible. Now Dunn identifies as non-binary trans masculine. His pronouns are he/they.
“And that for me means that although my gender expression is masculine and people read me as masculine, I don't identify as a man. I don't identify as male. I am me,” he said.
Trans masculine is among the growing spectrum of gender nonconforming identities — meaning they don’t identify as just male or female. For instance, Facebook now allows users to choose from more than 70 gender identities. A major study by Boston University’s School of Public Health published Friday in the American Journal of Preventive Medicine illustrates the challenges faced by people who don’t identify with traditional gender categories.
Sarah Ketchen Lipson, assistant professor of health law, policy and management at BU, led the study with a team that included researchers from Harvard Medical School and the University of Michigan’s School of Public Health. They surveyed more than 65,000 students across 71 colleges and universities nationwide, asking about their gender identity and mental health.
“We're looking at depression symptoms, anxiety, eating disorders, non-suicidal self-injury, suicidal ideation — which is thoughts of suicide as well as suicide attempts,” Lipson said.
Of the students surveyed, roughly 1,200, not quite 2 percent, identified as transgender or non-binary. What Lipson and her research team found about their mental health was staggering.
“The magnitude of these disparities was enormous. No matter which mental health outcome we were looking at, the gender minority population has significantly higher odds of having one of those mental health problems,” she said.
Gender nonconforming students are four times more likely to experience mental health problems than their peers who identify with the sex they were born with, also known as cisgender. And as Dunn puts it, finding a counselor who gets it can be daunting.
"Ten minutes up to an hour is just going through, ‘I'm trans, and this is what this means.’ And then getting into, ‘Here's what I'm coming to you for, whether it's helping with anxiety or depression or PTSD,’ or any other things that somebody might be seeking care for,” Dunn said. “Often times those things are put on the back-burner and you have to wade through the discussion of gender identity and gender expression first. And quite frankly, it’s exhausting.”
A small but growing number of colleges and universities have been trying to be more welcoming of gender nonconforming students. UMass Amherst launched its first initiative in 2007. Genny Beemyn, director of the university’s Stonewall Center and a nationally recognized expert on trans student issues, said the school has done a lot to try to support the trans population.
“We have gender-inclusive housing. We have made a serious effort to have gender-inclusive restrooms around campus,” said Beemyn, whose pronouns are they/them. “We give students the ability to indicate their pronouns which will appear on course rosters. We provide hormones and surgery coverage as part of our student health as well as our employee health.”
According to the Campus Pride’s Trans Policy Clearinghouse, 88 colleges and universities nationwide provide transition-related medical expenses. Nearly 270 campuses provide gender-inclusive housing. Twenty-one of them are in Massachusetts, including BU, UMass Lowell and Emerson College. But considering there are 4,000 colleges and universities, Beemyn said that’s a drop in the bucket and much more needs to be done, especially when it comes to the climate on campuses.
“Colleges really need to do a whole lot more to address harassment and discrimination, from micro-aggressions that take place on a daily basis with students being misgendered and not being recognized, to addressing larger issues — the fact that trans students experience the highest rates of sexual harassment of any group on college campuses,” Beemyn said.
Beemyn said UMass Amherst has a number of support groups for the LGBTQA+ population on top of counseling services. Additional support may be necessary as colleges and universities across the U.S. scramble to provide more mental health services for its students.
For the gender minority population, finding the right therapist can be even more challenging. Elizabeth Baumann, a clinical psychologist in Cambridge who specializes in trans and non-binary gender identity issues, said clinicians must empathize with their patients in a way they may never have before.
"If someone is coming to treatment to discuss the experience of having been stigmatized in the world, of having been misunderstood, not believed — which can often be really critical themes about trust — the clinician really has a mandate to sit with that experience for themselves and think about what it means to have a gender,” Baumann said.
BU's Lipson said her next research phase is to look more closely at the specific factors behind the mental health disparities. She said she hopes college administrators find the current study helpful.
“That's one of the groups I'm most interested in reaching and sharing these findings with. I think the implications are, how can we create a campus environment that's inclusive and supportive of transgender students?” Lipson said.
Dunn agrees there is a need for urgency but is quick to emphasize something else.
“We do have to do something for particularly the youth who are dealing with suicidality, with anxiety and depression and so many other really concerning aspects," he said. "But we also have to raise the narrative that there are trans folks out there who are succeeding, who are surviving, who are thriving in today's world.”
Correction: An earlier version of this story incorrectly stated the year that UMass Amherst launched its first initiative for gender nonconforming students. This initiative was launched in 2007.
