The Journal of the American Medical Association published a new study on Monday: Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women

I. e.-- Are transgender women just inherently nuts or we get help to be that way?

Objective: To report the prevalence of mental health, substance dependence, and comorbid psychiatric disorders assessed via clinical diagnostic interview in a high-risk community-recruited sample of young transgender women.

Results: Of the 298 transgender women, 41.5% of participants had 1 or more mental health or substance dependence diagnoses; 1 in 5 (20.1%) had 2 or more comorbid psychiatric diagnoses. Prevalence of specific disorders was as follows: lifetime and current major depressive episode, 35.4% and 14.7%, respectively; suicidality, 20.2%; generalized anxiety disorder, 7.9%; posttraumatic stress disorder, 9.8%; alcohol dependence, 11.2%; and nonalcohol psychoactive substance use dependence, 15.2%.

At the same time, most of these women were unemployed, more than a quarter lacked health insurance, and many lived in extreme poverty — all mental health stressors and potential effects of discrimination, said Johanna Olson-Kennedy, medical director of the Center for Transyouth Health and Development at Children's Hospital in Los Angeles, the largest transgender youth clinic in the United States.

That prevalence rates of depression are notably higher in this community sample of transfeminine youth and young adults than in cohorts recruited from care sites and underscores the potential influence of lack of access to services, both medical and mental health. Timely and appropriate care for transgender adolescents and young adults is imperative to help them achieve health and wellness.

--Olson-Kennedy, in an accompanying editorial

These findings contrast significantly with those of another study published this month, which looked at the mental health of 73 transgender children between ages 3 and 12. This younger group did not experience any more depression, and had only slightly more anxiety, than their siblings and nontransgender peers. But the differences between the two studies' participants are vast.

The majority came from homes with household incomes above $75,000. By contrast, nearly half the Chicago and Boston women had annual incomes below $10,000 a year. And although the participants in both studies had transitioned, the children had not yet entered puberty.

I think both of those studies, as all good studies do, leave us with more questions than answers. And that's good — that's a sign of good science, and that shapes the other things we need to look at.

--Olson-Kennedy

What I would love for people to understand is that we are really just starting to get a small understanding of trans youth. What's exciting is that the data is helping to validate what we know as clinicians, which is that people who are validated and supported in their selfhood are happier, have less mental health challenges and are more successful. We need to stop making people be who we think they should be and start letting them be who they are.

--Olson-Kennedy

In the name of full-disclosure, this author admits that she spent the entirety of her transition high on weed. Believe it or not, transition is hard...and we do what we have to do to get through it. Being high was not an attempt to escape from reality, but rather a method of surviving the reality that is the everyday life of a trans woman in transition, which comes replete with denial of who we are and daily threats to our person, our humanity, and our civil rights.