The Underlying Fears of Gender Transition: Understanding Their Impact on Your Mental Health

Person finds and opens the door in the maze-shaped brain on the wall

Gender transition is a complex and life-changing decision for transgender individuals that involves several challenges, including internal and external fears. These fears may include the fear of rejection, discrimination, and stigma, as well as the fear of losing close relationships and the fear of surgery or medical procedures. This blog post will explore the internal and external fears associated with gender transition, their impact on individuals and their families, and strategies to overcome them.

Internal fears associated with gender transition are those that arise within individuals who are considering or undergoing transition. These fears may include fear of not passing as the desired gender, fear of not being accepted by the LGBTQ+ community, fear of the unknown, and fear of regret. One study found that fear of not passing was a common concern for transgender individuals, particularly for those who were planning to undergo hormone therapy or surgery (Grant et al., 2011).

Another study found that fear of regret was a significant concern among transgender individuals who had undergone gender-affirming surgery (GAS) (Ainsworth & Spiegel, 2010). This fear may be related to the irreversible nature of GAS and the uncertainty of the long-term outcomes. Individuals may also fear that their decision to transition will be invalidated by others, leading to feelings of shame and isolation.

External fears associated with gender transition are those that arise from the societal and cultural pressures that transgender individuals face. These fears may include the fear of discrimination, rejection, and violence. One study found that transgender individuals who experienced discrimination and rejection had higher levels of depression and anxiety (Bockting et al., 2013).

Transgender individuals may also fear losing close relationships with family and friends. A recent study found that the emotional impact of transition on close family members included fear and grief, particularly related to the loss of the previous identity and the uncertainty of the future (Hill, Rozanski, Carfagno & Willoughby, 2017).

Overcoming fears associated with gender transition requires a supportive environment that includes access to appropriate healthcare, counselling, and social support. It is essential for individuals to work with healthcare providers who understand their unique needs and can provide appropriate care.

Transgender individuals may benefit from peer support groups that provide a safe and supportive space to share their experiences and learn from others. Family and friends can also play a vital role in supporting transgender individuals through their transition. This may include attending counselling sessions, learning about gender identity and expression, and advocating for their rights and needs.

Gender transition is a challenging journey that involves several internal and external fears. These fears may impact the mental health and well-being of transgender individuals and their families. It is essential for individuals to seek support from healthcare providers, peer support groups, and their loved ones to overcome these fears and achieve a successful transition.

Talking to peers who have gone through similar experiences can provide insight and support. Service providers can help guide you through the other aspects of transition, such as hormone therapy, coming out to family, or exploring surgical options. A gender-affirming psychotherapist can offer specialized support and counselling, helping you explore your feelings and goals, and work through any challenges that may arise.

Online psychotherapy with me can provide a convenient and safe space to discuss your gender transition concerns and receive support. As a licensed mental health professional, I offer a non-judgmental, supportive, and affirming environment where you can explore your identity, work through any issues that may arise, and develop a plan to achieve your transition goals.

Remember, your gender transition journey is unique to you, and seeking support from those who understand and respect your experiences is an important part of the process. Don’t hesitate to reach out to peers, medical professionals, or gender-affirming therapists to help you feel confident and informed in your decisions.


Ainsworth, T. A., & Spiegel, J. H. (2010). Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Quality of Life Research, 19(7), 1019-1024.

Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103(5), 943-951.

Hill, D. B., Rozanski, C., Carfagno, J., & Willoughby, B. L. (2017). Supporting transgender individuals and their families: best practices for child and adolescent psychiatrists. Journal of the American Academy of Child & Adolescent Psychiatry, 56(9), 757-764.

Disclaimer: This blog shares general information only, not professional advice or recommendations. Consult healthcare providers for personal guidance. Decisions based on content are the reader's responsibility. Thank you.

Clayre runs a group practice of three queer and trans therapists, including youth therapist Audrey Wolfe, RCC, LGBT therapist Camber Giberson, RCC, CCC, and gender-affirming therapist Clayre Sessoms, RP, RCT, RCC, CCC, ATR-P. Work with us: book a session.

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