Study: If Your ID Matches Your Gender, You’re Mentally Healthier (Also: Water Is Wet)

A report in the Philadelphia Inquirer this week revealed researchers at Drexel University concluded that transgender people who have official, legal identification bearing a gender marker that matches their gender identity generally enjoy better mental health than trans people who do not.

This is news?

Indeed it is, because the vast majority of Americans, those who are cisgender — a word meaning “not transgender” — do not recognize the hardships faced by trans Americans, especially in obtaining documentation that aligns with their presentation.

But that is changing, slowly, thanks to progressive lawmakers in 13 states who have pushed through non-binary gender markers on official documents including drivers licenses, and companies like Mastercard issuing True Name debit cards, matching the chosen name of retail banking customers who are trans, non-binary or gender non-conforming.

To those of us who are out and trans, this may seem like scientists announcing, “water is wet!” But given there is such a paucity of research into the lives of transgender people, it’s important that Drexel spent time examining this question. And please note: the scientists report no funding was expended for this study. Not a dime.

According to the Inquirer, the researchers analyzed 22,286 responses to the 2015 U.S. Transgender Survey using the Kessler Psychological Distress Scale. Harvard professor R. Kessler describes that as a questionnaire intended to yield a global measure of distress based on questions about anxiety and depressive symptoms that a person has experienced in the most recent four-week period.

The Drexel University study is believed to be the first in the country to examine the relationship between legal IDs and mental health. It was published in the Lancet Public Health Journal this month.

“Despite the barriers to legal gender affirmation for trans people, little is known about its association with mental health,” wrote Ayden Scheim, PhD., who authored the study along with Amaya G. Perez-Brumer, PhD., and Prof. Greta R. Bauer, PhD. “We therefore sought to determine whether having gender-concordant identity documents (IDs) is associated with mental health among trans adults in the USA. We hypothesised that having an ID that reflects one’s preferred name and gender marker would be associated with reduced psychological distress and suicide risk.”

Most trans people living in their authentic gender did not have IDs that matched how they lived, according to the study: fewer than 11% of respondents indicated that all of their IDs reflected both their preferred name and gender marker.

Among the reasons: the cost, bureaucratic red tape, a lack of appropriate non-binary or gender non-conforming options such as beyond male or female, and perceived ineligibility. Probate court filing fees to change a legal name typically cost several hundred dollars.

Complicating matters: several states have or are considering making it illegal for a transgender person to change the gender marker on their birth certificate. Idaho Republicans want to do this; by contrast, New York has expanded this option to include minors. At present, the U.S. State Department still allows trans Americans to change the gender marker on passports.

According to the U.S. Trans Survey, the majority of those whose IDs did not match their identity reported poverty-level incomes and more than half have not undergone gender-affirming surgeries.

It’s a fact that bears repeating: the vast majority of trans Americans do not have “the surgery,” either because of financial, insurance limitations, medical, or personal reasons, and live in poverty — experiencing a 15% unemployment rate, three times higher than the unemployment rate in the U.S. population when the survey was conducted (5%). With the coronavirus pandemic driving unemployment claims nationwide to a record 3.3 million this week, trans Americans are again likely to be suffering even more than most.

As to how many people are impacted: A study in 2016 by the Williams Institute at UCLA estimated there are 1.4 million out transgender adults, or 0.6% of the population. That number doesn’t include children; an untold number of adults remain in the closet or live “stealth” — preferring not to disclose their gender history.

Another interesting finding: where a trans person lives has a lot to do with the status of their identification papers. Participants in western states were more likely to have what the researchers called “gender-concordant IDs,” and those in the midwest were less likely.

The research team concluded that trans Americans whose ID matched their everyday life experienced a 32% reduction in “serious psychological distress,” and up to 25% reduction in suicidal ideation and suicide planning, compared with having an ID that outed them as transgender.

They state that gender-concordant ID status was not directly associated with suicide attempts, but that the lack of such identification may ultimately be a factor contributing to depression and other causes of suicide ideation or attempts. This is important because trans people consider and attempt suicide at a significantly higher rate than cisgender people.

The average suicide rate in the U.S. is believed to be about 2%, but a 2019 study found suicide ideation averaged 46.55% and attempts averaged 27.19% within the trans community. This is not, as some claim, a sign of mental illness, but an outcome of the societal and familial rejection and discrimination trans people experience, and their inability to find acceptance living in their authentic gender. That means almost half of trans adults in the U.S. have considered ending their lives because of how badly people treat them.

What’s the solution? Create greater acceptance for this marginalized community, and making ID changes simpler and less costly is one big step in that direction. The National Center for Transgender Equality has a feature on its website to research changes, state by state. The Transgender Law Center also has resources online. Lambda Legal and the ACLU also offer guidance online.

The Transgender Legal Defense and Education Fund (TLDEF) provides pro-bono assistance in getting legal documents changed. Click here to learn more.