Postpartum Depression in Transgender or Gender Nonbinary (TGNB) Parents
The terms "transgender" and "nonbinary" refer to people whose perception of their own gender differs from the sex they were assigned at birth (male or female). For example, transgender men were assigned female at birth but identify as men. Nonbinary people generally do not identify as men or women. They may feel they are either a combination of both or something else entirely.1
In the United States, TGNB people account for up to 2 percent of the total population. Among them, many transgender men and nonbinary people can get pregnant and give birth. These people may be taking hormone therapy (testosterone) but have not had surgery to alter their reproductive organs.1
The United States does not collect data on how many TGNB people give birth or what their experience is like during or after pregnancy. However, experts believe the number of TGNB parents is growing. And because TGNB people have higher rates of mental illness than non-TGNB (cisgender) people, their risk for postpartum depression is a concern.1,2
What is postpartum depression?
Postpartum depression (PPD) is a serious mental health condition that can occur during pregnancy or after childbirth. It lasts longer and is more severe than the "baby blues" that new parents often experience. Symptoms of PPD may include:3
- Feeling very sad or crying a lot
- Loss of interest in doing things you once enjoyed
- Extreme tiredness (fatigue)
- Sleeping too much or too little
- Changes in appetite
- Trouble bonding with your baby
- Intense mood swings, from irritability to hopelessness
- Anxiety or panic attacks
- Feelings of guilt, worthlessness, or being a bad parent
- Thoughts of harming yourself or your baby
Importantly, PPD is not limited to any 1 gender. It can occur in cisgender, transgender, and nonbinary people. And while it most often affects the birthing parent, partners and spouses also can develop PPD.3
Unique challenges for transgender and nonbinary parents
The lack of data about TGNB parents makes it hard to predict how often PPD may affect this group. However, transgender and nonbinary people may be more at risk for PPD for several reasons.1,2
Gender dysphoria
TGNB people experience feelings of gender dysphoria. This term means distress caused by their physical bodies not matching up with their gender identity. Gender dysphoria plays a role in higher rates of depression and self-harm among transgender people.1,2
Becoming pregnant may strengthen gender dysphoria for transgender men or nonbinary people. This may stem in part from society’s treatment of pregnancy as an experience that only women have.1,2
Also, transgender men typically stop taking hormone therapy during pregnancy and right after giving birth. This may cause them to transition back to a body that they do not feel comfortable in. These changes to their bodies may increase their gender dysphoria.1,2
After giving birth, many TGNB parents want to give their children the benefits of breastfeeding. In this case, it may be called chestfeeding. Studies show that about half of transgender men, even those who have had surgery to remove their breasts, chestfeed their babies. But doing so is another factor that may make their gender dysphoria worse.1
Social stigma
Visibility and understanding of TGNB people are increasing in our society. But prejudice is still common. Many people do not understand or respect the gender identities of TGNB people. This is called transphobia.1
Some people may be especially confused by a male-presenting person with a pregnant belly. They may shun or shame the person. They may even make the person feel threatened or unsafe.1,2
Experiencing trauma or abuse, lack of social support, or poor healthcare can all put anyone at higher risk for mental illness during pregnancy. Many TGNB folks have had some or all of these experiences due to social stigma.2
Stigma also can lead pregnant TGNB people to feel lonely or isolated. Having these feelings during pregnancy is known to increase rates of PPD.2
Barriers to gender-affirming healthcare
One-fourth of transgender people have had a negative experience with the healthcare system in the last year. These experiences may stem from several factors, including:1
- Bias and prejudice among healthcare professionals – The makeup of the healthcare system reflects the overall makeup of society. And transphobia is still common everywhere.
- Lack of education for healthcare providers – There are not many educational resources about providing care to the TGNB population. Also, most providers have been exposed to very few TGNB patients, so they lack real-world experience.
- Lack of insurance coverage – Many insurance plans do not cover gender-affirming treatment such as hormone therapy. This leads to higher healthcare costs.
Because of these barriers or fear of mistreatment, many TGNB people avoid the healthcare system. In fact, close to half of pregnant transgender men receive medical care from someone other than an ob-gyn, like a midwife.1
But without proper care and treatment, their and their babies' health outcomes will be worse. This includes mental health outcomes.1
Hope on the horizon
Many healthcare experts realize that medical professionals need better education about how to provide affirming care to TGNB people. For example, one major medical center has launched a new training program for labor and delivery nurses. The training teaches them how to provide inclusive care to pregnant transgender men.4
Some national organizations also provide educational resources about the TGNB community for healthcare providers. These groups include the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National LBGTQIA+ Health Education Center. There are also several groups dedicated to researching issues in transgender healthcare.5
Get help for postpartum depression
Everyone’s experience with pregnancy and childbirth is different. And much more research is needed to understand what new TGNB parents go through.
However, some pregnant TGNP people may feel isolated and misunderstood. They may feel like they are stuck in a situation that does not allow them to be their true selves. And medical professionals and others in their community may not treat them with respect or offer the support they deserve. All of these factors may put transgender or nonbinary parents at greater risk for developing postpartum depression.1,2
If you or a loved one is having symptoms of PPD, seek medical care right away. To find a gender-affirming healthcare provider, you can use the World Professional Association for Transgender Health's provider search tool. The tool lists providers of varying specialties, including mental health.