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6 Mental Health Stressors for Transgender, Non-Binary, and Gender Non-Conforming Employees at Work

6 Mental Health Stressors for Transgender, Non-Binary, and Gender Non-Conforming Employees at Work

As a transgender man, and a board-certified physician in family medicine and addiction medicine, I can attest to how hard it is to deal with identity-related stress and work-related stress at the same time. Being transgender, non-binary, and gender non-conforming (TG/NB/GNC) in the workplace isn’t easy, so it’s helpful when an employer can help lighten that load. Stress is a normal part of life,  and everyone can benefit from good mental health support–but your TG/NB/GNC employees face a unique set of pressures both in and out of the workplace. Support for the mental health of your TG/NB/GNC employees is crucial, and it starts with understanding and addressing their stressors.

Background: Transgender, non-binary, and gender non-conforming mental health disparities

The TG/NB/GNC population is at risk for a variety of mental health problems. TG/NB/GNC people suffer from higher-than-average rates of depression (44 percent), anxiety (33 percent), and substance use disorders. Around 40 percent will attempt suicide at some point in their lifetime.

TG/NB/GNC discrimination in the workplace, society, and the health industry compound these struggles.

  • Discrimination in society shows up in anti-trans legislation, violence against TG/NB/GNC people, personal prejudice from friends and family, and many other acts large and small.
  • Workplace discrimination can include harassment, job loss, acts of violence, and more.
  • Health care discrimination makes it difficult for patients to find doctors who practice gender-affirming care. Procedures such as gender-affirming surgery are often not covered by insurance.

Facing continuous discrimination becomes an active barrier to seeking health care, including mental health care. A large 2015 survey of TG/NB/GNC individuals found that nearly a quarter of TG/NB/GNC people had avoided needed health care in the past year because they were afraid of mistreatment from providers. More recent estimates put this number closer to one in three.

Given the scope of TG/NB/GNC mental health disparities and the need for treatment, employers should make gender-affirming mental health care a priority for their workforce. That’s why Lyra Health ensures that our network of providers includes therapists trained in treating the LGBTQIA+ community.

6 work stressors for TG/NB/GNCmployees

What challenges do your TG/NB/GNC team members face, and what can you do about it? Here are six of the most common stressors.

1. Lack of job security

In some instances, a TG/NB/GNC identity can affect job security or an employee’s ability to remain at a job they like. According to the National Center for Transgender Equality:

“…more than one in four transgender people have lost a job due to bias, and more than three-fourths have experienced some form of workplace discrimination. Refusal to hire, privacy violations, harassment, and even physical and sexual violence on the job are common occurrences, and are experienced at an even higher rate by transgender people of color. Many people report changing jobs to avoid discrimination or the risk of discrimination.”

Fearing job loss can take an incredible toll on mental health. I remember the anxiety I had in medical school when I had come out as trans and was considering a medical transition. My managing resident shared with me that some of our coworkers had made transphobic comments, and advised me against transitioning out of concern for my safety and career.

I went ahead with my transition, but that conversation was a sobering moment–all the more so because it happened in San Francisco, a supposed “liberal bubble.” How much more tenuous would my position have felt if I were in a region known for being less accepting of LGBTQIA+ identities?

2. Lack of safety at work

Being out as TG/NB/GNC in the workplace can bring risks. Your TG/NB/GNC employees may fear rejection, judgment, or even physical assault, which are all unfortunate realities at some companies. Unless you actively affirm and enforce a nondiscrimination policy that includes gender identity, your TG/NB/GNC employees have no way of knowing whether you will support them in these difficult moments.

Other incidents in the workplace can make TG/NB/GNC employees feel vulnerable. Coworkers may put them on the spot and expect them to share their personal stories. Employees who have not publicly come out at work may fear being outed by an in-the-know coworker. All of this uncertainty can erode mental health at work.

Your TG/NB/GNC employees may also face discrimination in their personal lives. I’ve worked with people who were kicked out of their homes or attacked by neighbors. As an employer, it’s critical to understand that your LGBTQIA+ employees may go through personal crises outside of work due to their identity.

3. Microaggressions

Even if the work environment is not openly hostile to TG/NB/GNC colleagues, small acts of discrimination, called microaggressions, can still wear a worker down over time. Perhaps a coworker cracks a mildly transphobic joke at the water cooler. A manager exclaims that an employee “look good” for a transgender individual. Their presence in the restroom makes someone else nervous. Coworkers may intentionally use an incorrect pronoun. These small gestures can build up and create an uncomfortable work environment.

4. Name change logistics

Officially name changes as part of a transition can be tricky at work. Most institutions have procedures in place for changing last names upon marriage, but when a TG/NB/GNC employee tries to change their first name to reflect their true gender identity, they’ll find fewer processes and support systems. It may be difficult to make the switch on an insurance policy or social security account, or to access work records from a former job under a different name. I’ve worked with people who worried about losing access to all of their previous career documentation.

5. Constant insecurity

Many important aspects of life can feel tenuous to someone who is TG/NB/GNC. In addition to  job security and housing can feel uncertain, acceptance from friends, loved ones, and coworkers may not be guaranteed. A barrage of anti-trans legislation in recent years has cast uncertainty over the future of our freedoms. And many TG/NB/GNC people fear losing access to the medications that help achieve and maintain a physical transition, which adds even physical bodies to the list of uncertainties.

TG/NB/GNC employees may be negotiating these fears in ways coworkers and managers don’t see, and it can negatively impact their well-being and their performance at work.

6. Lack of gender-affirming health care

Providing physical and mental health care benefits to your employees does not mean all employees will receive adequate care. Gender-affirming care can be difficult to find. Some physicians refuse to treat TG/NB/GNC patients, even refusing them common procedures that are offered to cisgender patients.

The medical system in general is not structured to support TG/NB/GNC identities. Health forms don’t always present patients the opportunity to share their gender identity, and medical resources tend to be written to a cisgender audience.

Due to this lack of support, some argue that the TG/NB/GNC identity should continue to be categorized as a “disease” by medical science. After all, there’s plenty of support and research for doctors who want to specialize in treating diseases, and less motivation to specialize in patients who are considered “healthy.”

Be aware that your TG/NB/GNC employees who need care or face acute or chronic health problems may be struggling to find a provider they trust.

Practical steps you can take

How can a workplace best support TG/NB/GNC team members? What practical steps can you take to make them feel not only welcomed and affirmed, but actually cared for?

  • Start at the very beginning of their interactions with your company. Does your employment application make it easy for potential employees to communicate their identity? Ideally, forms should ask for pronouns and for preferred name, not just their legal name.
  • Use inclusive language in company documents and communications.
  • Establish clear and easy processes for employees who wish to change their name. Offer assistance resources for the more complex steps such as name changes on insurance policies.
  • Make bathrooms accessible and gender-neutral, and encourage employees to use whichever bathrooms best align with their gender identity.
  • If you provide health insurance to your workforce, make sure it serves TG/NB/GNC individuals well. Your provider network needs to include physicians who are equipped to provide gender-affirming care, and affirming treatments such as surgery and hormone therapy should be covered. Your mental health benefits should include providers who are trained for cultural competence and LGBTQIA+ mental health needs.
  • Communicate and enforce a no-discrimination policy. Let workers know that your company values all identities, and spell out consequences for anyone who discriminates or harasses based on another person’s identity. If those rules are violated, enforce those consequences promptly.
  • Include LGBTQIA+ identities in anti-discrimination workplace training courses.

Finding the right mental health benefit for your TG/NB/GNC employees

Just as people from different racial and ethnic backgrounds have some mental health needs that are unique to their demographic, TG/NB/GNC people need mental health providers who are educated about their experience and best treatment practices. 

When looking at mental health benefits, here are some key things to look for:

  • They use evidence-based care. The LGBTQIA+ community has historically been subjected to harmful care that was not evidence-based, such as conversion therapy, which can be further damaging to their mental health.
  • Treatment providers who understand that biological sex and gender identity are separate but related concepts.
  • Providers that recognize that there’s no one-size-fits-all approach for the gender affirmation process. For example, some individuals will seek medical transition, while others may not want to or be able to.
  • Providers who understand that gender-affirming surgery has real psychological benefits for those who desire it. It can lead to a 46 percent reduction in psychological stress and a 44 percent reduction in suicidal ideation.

Mental health professionals like those at Lyra play a pivotal role in helping TG/NB/GNC employees lead healthier, happier lives.


If you want help connecting with a coach or therapist, Lyra can assist you. You can get started today if Lyra is offered by your employer. Sign up now.

For employers who want to learn more about the value and impact of a mental health benefit, download our white paper or get in touch.

And check in frequently here or follow us on FacebookLinkedIn, and Twitter for more insights into supporting employees’ mental health.

By Alann Weissman-Ward, MD
14 of June 2022 - 8 min read
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