Gender Stereotyping and Gender Minority Stress

Written by Gretta Strand

The experiences of gender stereotyping for transgender individuals are complicated and nuanced due to the many ways that these individuals can encounter such stereotyping: in regard to the sex at which they were assigned at birth, in regard to their expressed gender identity, and in regard to them having a gender identity that is different from the sex they were assigned at birth. The impacts of this experienced stigma and stereotyping are evident in many realms of both physical and mental health including higher instances of depression, anxiety, social isolation, and eating disorder diagnoses, as well as lower reported quality of life, sleep, and health care utilization. Though this is by no means an exhaustive list of the impacts of gender stereotyping, the impacts can be seen in areas that are foundational to living a healthy life. It is imperative that clinicians attend to the complex gender tapestry of those they serve in order to provide well-rounded and gender-informed care.

There are many dimensions that make up one’s gender-related experiences. According to research conducted by Kuper et al., these dimensions include gender identity, gender presentation, gender expression, and physical self-image (2018). Gender identity is one’s internal sense of their own gender as well as the perceptions that they desire others to have in reference to their gender. Gender presentation includes characteristics related to appearance such as hair, clothing, or make up. Gender expression includes characteristics related to personality such as interests, activities, interactions with others, and the social role you play in your interactions with others. Lastly, physical self-image has to do with the body, including the desired primary and secondary sex characteristics. When it comes to feeling affirmed in one’s gender, individuals will weigh these dimensions differently and these dimensions are often fluid across the lifespan, even for cisgender individuals. Individuals can experience gender stereotyping across all these dimensions as well, especially when one’s gender-related experiences may not fit neatly into one box across all dimensions.

The types of gender stereotyping experienced by transgender individuals can vary greatly and expands far beyond the stereotypes of simply “male” or “female”. One study by Howansky et al. compiled the most common stereotypes for cisgender men, cisgender women, transgender men, and transgender women (2021). Stereotypes of cisgender men included aggressive, ambitious, arrogant, and insensitive while the top stereotypes for cisgender women were weak, caring, shallow, unintelligent, and emotional. Conversely, stereotypes for both transgender males and females included words such as deviant, confused, sexual, and mentally ill. Across the board, the gender stereotypes listed for both cisgender and transgender individuals were negative, harmful, and largely untrue. This language also indicates that transgender individuals are more likely to be stereotyped in ways that undermine their humanity and autonomy. Additionally, this study found that participants feel that transgender people are more stereotypically aligned with their sex assigned at birth, rather than their gender identity, and there seemed to be a sort of ambivalent application of both male and female stereotypes to transgender individuals. This highlights much of the gender-related stigma faced by transgender individuals: experiencing stigma associated with the sex they were assigned at birth, stigma associated with being trans in general, and the nuanced impacts of male and female stereotypes which may or may not be aligned with their gender identity.

The endorsement of gender stereotypes, or the extent to which you believe that people should embody distinct traits based on gender, is an important piece of the puzzle to understanding the impacts that gender stereotypes have on transgender youth. Based on a study by deMayo et al. (2022), there seems to be low gender stereotype endorsement among cisgender and transgender adolescents and high levels of gender stereotype flexibility (believing that both men and women should possess a certain trait). This study also found that parents of transgender youth had even lower levels of gender stereotype endorsement than the youth participants. A similar study conducted by Olson and Enright found that transgender children and siblings of transgender children had greater tolerance of gender nonconformity than other cisgender children (2018). Even though this evidence paints an optimistic picture of how youth are engaging with gender stereotypes, this does not mean that transgender youth are immune from the impacts of gender stereotyping. Transgender female youth are at particular risk for harm due to the rigid expectations placed on those assigned male at birth, compounded with the unrealistic beauty and body image standards for young girls (Ignatavicius, 2013). This can result in family rejection, bullying, anxiety, depression, and suicidality, among other outcomes. Though these outcomes are unfortunately common among many transgender and gender-diverse youth, transgender female youth are at a uniquely vulnerable intersection for these negative outcomes.

Terms such as “passing” and “stealth” are important facets of the transgender experience worth considering when thinking about gender stereotyping. Passing is the experience of being perceived as the gender that you identify with, which is not necessarily a goal for all transgender individuals- many navigate gender expression without intending to pass. Additionally, passing is not a conscious choice bur rather based on others’ perceptions of your gender identity, which can vary widely. For some transgender individuals, attempts to pass are aimed at acceptance, avoiding social rejection, or are a means to acquire some level of safety or comfort (Dias et al., 2021). Experiences of gender stigma and stereotyping can be related to passing: those who do not “pass” may experience stigma related to being identifiably transgender, and those who do “pass” may experience negative gender stereotyping associated with their gender identity. Notions of passing can reinforce a gender binary which is at the core of all gender-based stigma and stereotyping, and is therefore worth deconstructing.

“Stealth” is a term used for transgender individuals who are not out as transgender or have not disclosed their gender history in the spaces they inhabit, whether it be at work, school, or in social circles. This can especially be true for individuals who identify more with their current gender identity than with the transgender experience itself. Though not always the case, this can also be common for transgender individuals who transitioned as young children. Similar to attempts to pass, being “stealth” may offer transgender individuals a sense of safety, feelings of acceptance in their everyday life, and the possibility of avoiding exposure to day-to-day discrimination (Bränström & Pachankis, 2021; Rood et al., 2017). However, it is important to consider that like passing, being “stealth” is largely based on other’s perceptions of your gender identity which can be a source of stress as well. The constructs of “passing” and being “stealth” are complicated and nuanced and vary greatly based on individuals’ experiences with discrimination, structural stigma in the places they live, and access to gender affirming care.

To begin to understand the health impacts of gender stereotyping, it is important to understand the idea of minority stress, and particularly, gender minority stress. Minority stress is the idea that people of minority identity groups are subjected to unique forms of social stressors not experienced by those in dominant groups (Tan et al., 2020). These social stressors act as a “load” to bear on individuals, and carrying this load over time can manifest in poorer health and mental health outcomes. Subsequently, the gender minority stress framework considers the specific stressors that are unique to gender minority individuals which can help to explain the mental health disparities between cisgender and transgender individuals (Testa et al., 2015).

In one study comparing transgender and cisgender adolescents, transgender participants had statistically significant higher depression scores and anxiety scores (Hunter et al., 2021). Additionally, well-being scores (based on the Warwick-Edinburgh Mental Wellbeing Scale) in the transgender population were significantly lower. This study also found that exposure to distal and proximal stress, including instances of discrimination and victimization, was associated with greater anxiety and depression. A study on gender minority stress focusing on an adult transgender population found similar results- disproportionately higher rates of depression, anxiety, somatization (or the physical manifestation of depression and anxiety symptoms), and overall psychological distress (Bockting et al., 2013). This study found that these negative mental health outcomes were associated with experiences of stigma, but that protective factors for these outcomes included family support, peer support, and identity pride.

As just previously mentioned, family and peer support are well documented protective factors for transgender individuals in regard to mental health outcomes. However, it is also well documented that this population faces challenges with social isolation and feelings of connectedness. One systematic review conducted by Garcia et al. found high levels of perceived loneliness, perceived burdensomeness, and expected rejection in LGBTQ youth, and these experiences were all associated with negative mental health outcomes (2020). This study also described the dynamics that are likely to lead to social isolation which include othering, social invisibility, and bullying. Interventions that promote mentorship, allyship, and peer-to-peer support networks seem to be affective in counteracting the social isolation commonly experienced by this population.

The consideration for quality of life, which is made up of facets of mental health, physical health, and socioeconomic conditions, is imperative for understanding the impacts of gender stereotyping on transgender youth. Health-related quality of life (HRQOL) is a widely used measure in the field of public health and is defined as an individual’s perception of their position in life in relation to their goals, expectations, standards for living, and broadly defined concerns. One study by Zou et al., found that transgender youth have significantly lower overall HRQOL compared to cisgender youth living with chronic disease, excluding those with rheumatoid arthritis and cerebral palsy (2018). They also found that transgender youth have reported physical functioning and psychosocial functioning that is lower or similar to chronically ill youth, again, aside from those with rheumatoid arthritis and cerebral palsy. The findings from this study indicate that the stress and stigma associated with being trans can manifest similarly in ways a chronic illness would, especially in regard to HRQOL.

With this in mind, it makes sense to consider the role that health care providers could play in promoting the overall physical and mental health of transgender youth. However, health care utilization in this population has been consistently and historically low. One study by Rider et al. found that transgender and gender nonconforming youth were more likely to report a poorer health status than their cisgender counterparts in addition to reporting lower rates of preventative health check ups (2018). Additionally, transgender youth reported staying home from school because of illness more often and visiting the school nurse’s office more regularly than cisgender youth. These findings illustrate the impacts of not having access to or utilizing preventative health visits: missed days of school, poorer over all health, and needing to supplement preventative health care with visits to the nurse’s office.

Participation in physical activities and recreational sports is one well known way that individuals can improve and promote health in their everyday lives. However, transgender youth are significantly less likely to participate in a team sport or other types of physical activity (Espinoza et al., 2023). This study also found that transgender youth had lower rates of team sport participation than youth who were questioning their gender identity, suggesting that the consolidation of a transgender identity can be a particular barrier to participating in sports. A similar study conducted by Clark and Kosciw found that transgender males and nonbinary youth had the lowest likelihood of sports participation in a school setting (2022). This study highlighted predictors of sports participation among LGBTQ youth which include participating in other non-sport extracurricular activities, but that overall, LGBTQ youth had lower levels of reported school belonging. The benefits to participation in sports and other physical activities for youth are well documented. Researchers Barrera et al., highlighted the benefits seen in metabolic health and bone density, which are directly related to side effects of gender affirming hormone care and the use of puberty blockers (2022). There are also benefits to mental health such as decreased depressive symptoms, lower rates of social isolation, and less social anxiety.

Sleep is another aspect of physical health that is foundational to living a healthy life. One study conducted by Levenson et al. found significant disparities in sleep between transgender and cisgender youth (2021). They found that transgender youth are sleeping fewer hours, are more likely to report being “poor sleepers” and are more likely to report sleep problems such as sleeping too few or too many hours. Some explanations for this disparity in sleep quality include the impacts that gender minority stress have on transgender youth (i.e., higher cortisol levels), a higher likelihood of experiencing homelessness, and a greater likelihood of having an unsupportive home or family environment. The impact of having poor sleep over an extended period of time can include effects on one’s metabolism, immune system, depression symptoms, focus, and many other aspects of health.

Lastly, the realm of eating disorders is another facet of health that is greatly impacted by gender stereotyping and affects transgender youth in a unique and acute way. Adolescence is a time of heightened risk for body dissatisfaction and disordered eating due to the particular combination of biological changes and sociocultural pressures faced during puberty (Romito et al., 2021). For transgender youth in particular, there is high prevalence of gender dissociation (or the sense of psychological distance from one’s body), dissatisfaction with body size, and the intersection of those two experiences (McGuire et al., 2016). One study by Coelho et al. found that transgender youth are more likely than cisgender youth to engage with eating disorder behaviors (2019). They also found that these behaviors were often aimed at controlling pubertal development, attaining physical characteristics that were more consistent with their gender identity, or lessening the appearance of undesired sex characteristics. Transgender adolescents also have higher odds of engaging in risky body changing behaviors such as fasting for greater than 24 hours, using diet pills, and taking laxatives (Guss et al., 2017). Higher rates of eating disorders and eating disorder related symptoms are significantly associated with the presence of a gender dysphoria diagnosis, and it seems that access to gender affirming care helps to lower the presence of eating disorder-related outcomes (Feder et al., 2017).

Evidence for the impacts of gender stereotyping on transgender adults and adolescents is well documented and spans across many dimensions of physical and mental health, including depression, anxiety, social isolation, reported quality of life, sleep, physical activity, health care utilization, and eating disorder prevalence. The experience of gender stereotyping on transgender individuals varies widely depending on the structural stigma where they live, access to gender affirming care, social support, and experienced satisfaction with various facets of gender expression. It is imperative for clinicians to take a nuanced and whole-body approach to serving patients experiencing gender dysphoria in order to fully account for the impacts of gender stereotyping on this population.

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