There is an incredible amount of evidence showing that transgender people who experience stigma and discrimination experience higher rates of depression, substance abuse, and suicide. One researcher is trying to connect the dots by documenting how transgender people respond to each incident of rejection they experience — research inspired by her own transition journey.

Bethany Grace Howe, a media studies PhD student at the University of Oregon, is trying to figure out how individual incidents of transphobia (microaggressions) affect transgender people on a day-to-day basis. After some preliminary research, which she has presented at conferences but not yet published in a peer-reviewed journal, she has come up with a model she refers to as “TIDE” (transgender identity defense-related emotions).

The TIDE scale is similar to a thermometer of negativity that increases as transgender people face situations in which they must defend the legitimacy of their gender identity. Howe’s research suggests that the more intense and common these situations are, the more overall emotional distress transgender people tend to experience.

In a conversation with ThinkProgress earlier this year, Howe explained that her own challenges transitioning later in life very much motivated her to pursue this research. “I had this kind of epiphany,” she said, “that transgender people not only spend an enormous amount of time defending their equality, we spend a lot of time defending our existence. It was just such a simple thought to me, so simple, so clear cut, so clear as day, that I couldn’t imagine somebody else hadn’t come up with it.”


She set to work investigating whether the emotional impact of defending one’s existence was measurable. First, she formed several focus groups of LGBTQ people around the country, inviting them to share their daily experiences about what messages they received related to their identity. She subsequently turned that into a survey assessing both interpersonal microaggressions as well as messages people might hear through the media.

What Howe found is that transgender people have a unique experience compared to cisgender people, including those who might identify as LGBQ. “When it comes to defending your identity on a daily basis, when it comes to defending your existence, when it comes to defending whether or not you belong as a member of the human race — this happens to trans people more than any of the other people that I studied,” she explained. Finding those results, she said was the “second best day” of her life, “other than the birth of [her] daughter.”

The research also spawned a host of new questions. Howe said one of the most “surprising and confounding” findings was that transgender people experience the same level of emotional distress regardless of whether or not the rejection comes from an interpersonal interaction. This was true regardless of how resilient respondents were to those triggers.

“Media denials of their identity were as personally harmful to them emotionally as real life ones,” she said. “I was not expecting that in the least.”


Howe put this to the test in a small follow-up study conducted three days after The New York Times published its October report that the Trump administration was considering a proposal that would erase any recognition of transgender people in federal policy.

Among transgender respondents who’d read the study, 77.1 percent had a high or nearly-high increase in TIDE with another 16.1 percent experiencing moderate increases in TIDE. Those who experienced moderate to high levels of this identity-related stress reported feeling worn down (47.8 percent) and pained (52.2 percent).

Of those who had not read the article, 71.4 percent experienced a moderate increase of TIDE just from reading the headline. The Trans Lifeline and Trevor Project suicide prevention hotlines reported massive increases in call volume in the week following the story.

Earlier this month, Howe wrote about her findings for The Conversation. “[…] There’s clearly a negative impact on the mental health of transgender people when their identity is denied in this way,” she said.

Howe hopes the research she’s collecting will create diagnostic tools that will help identify transgender people who are most at risk for suicide-related behaviors. “The rate of transgender suicide and ideation is incredibly high,” she explained. “As somebody who’s been through that myself, if there is something we can give to counselors and mental health professionals that would say okay, this person is more at risk, this person is suffering more, I could do that and I could die and feel like — okay, I contributed to the world.”

The research has shown “significant relationships between people who rank themselves higher on the TIDE scale and who show a propensity toward suicidal ideation,” she said. Now it’s just a question of determining whether it’s merely correlation or causation.


In the meantime, Howe also hopes her research encourages people to think twice about the kind of language they use when discussing transgender people, whether it’s in the media or in person. She shared an incident when she herself was in Dallas to interview people for her research and a server at a drive-through window laughed at her, asking if she’d just come from a costume party.

“It absolutely took the wind out of my sails,” she recounted. “I was having a great day and I was all of a sudden having an awful day. I was distracted for the next 24 hours.”

Howe is currently sorting her findings into articles for publication in various journals and continuing to collect more data, hoping to shine a spotlight on the topic. So far, her work has attracted attention from figures like retired Olympic gold medalist Caitlyn Jenner, who agreed to fund her travel across the country interviewing more transgender people. “They’re very happy with what I’m doing,” she said of Jenner’s namesake foundation, which provides grants to organizations helping transgender people. “I couldn’t ask for better research partners.”

“I’m being given the time and the money to go find these people,” she added. “I’m going to talk to as man people as I can, because I can.”