Brian Rood is an assistant professor of psychology at Augsburg College in Minneapolis.

After I transitioned I applied for a job there in the Department of Mathematics, but they said they had no openings at the time.

Rood and some colleagues interviewed 30 adults who identified as either transgender or gender nonconforming in 2014-15 for what Rood called the Transgender Stress and Health Study. Results of the study were published in August in the journal Transgender Health.

Like soldiers returning from war, people who are transgender live lives on high alert, expecting everyday interactions with the gender-conforming world to turn negative or even violent.

This expectation of rejection and anticipation of negative interactions fuels the internal and external lives of transgender and gender nonconforming (TGNC) individuals, leading them to experience high rates of fear, anxiety, isolation, substance abuse and even suicide

Rood self-funded the research.

The NIH doesn’t prioritize transgender research. When you look at where the money is going, it primarily goes to HIV-focused research with gay men. Mental health research with transgender individuals is a low priority at this point. It is incredibly difficult to get funding for transgender issues unless you are a prolific researcher who is good at getting funds.

--Rood

I started my research experience in public health, in HIV prevention. I worked in that area for several years. In research about the AIDS epidemic, the focus was on cisgender gay men. Over time, I realized that even in queer research there is a big priority placed on the experiences of gay men.

Over the years, it became clear to me that there wasn’t enough attention given to transgender health, which is sad. That realization got me interested in persuing research on transgender health and mental health. Very few people were doing this kind of research when I got started. I wanted to increase visibility on the topic and share the narratives of trans people.

Ilan Meyer from UCLA developed a model called the Minority Stress Model. The short of it is that when you compare primarily gay and lesbian people with straight or heterosexual individuals, there are disparities when it comes to mental health, depression, anxiety and suicide. There are a lot of questions about of why that is. Meyer’s model helps us to understand that individuals with a minority identity like being gay or lesbian will experience unique types of stress. Those stress experiences include not only inactive, external experiences with stress — those that happen to a person from the outside — but also something called internal or proximal stressors that originate within a person. Trans people experience those same stressors but to an even greater degree.

When it comes to transgender research, the majority of studies focus on external or enacted experiences, like discrimination, violence and stigma — negative things that happen to trans people. We know there are a lot external stressors going on in the trans community. One example would be the high rate of murder of trans people. Another would be workplace discrimination.

--Rood

Internalized stressors for trans people include internalized stigma, identity concealment and fear of rejection.

An example of identity concealment would be a trans person who hides who they are out of fear of something bad happening to them if someone figures out (i.e. living stealth). This could also include someone who identifies as gay but doesn’t come out because they are afraid of violence or their family rejecting them. Internalized sigma includes internalized homophobia. When we hear these negative messages about homosexuality, we begin to internalize them and ultimately believe them.

The third type of internalized stressor is the expectation or fear of rejection. This would be is if someone worries that because of their identity if they go somewhere in public something bad might happen to them. An example of fear of rejection would be if a trans person thought, “I’m worried about using the restroom because someone might attack me if they realize that my gender identity doesn’t match my sex assigned at birth.” This would be a highly stressful situation for someone to anticipate or worry about happening.

All the research that we have shows that we really ought to be allowing trans individuals to use their preferred restroom. Otherwise they are at greater risk of being victimized. These are stressful situations. Trans people want to use the restroom and get in and out like any other people. They don’t have larger motivations.

--Rood