Post-Transition Depression: Why You Still Feel Empty by Dr. Z

You've completed your gender transition—whatever that means for you personally. Hormones, surgeries, legal documents, and social presentation. You're living authentically in your gender. So why do you still feel sad sometimes? Why is there this lingering emptiness, this low-grade depression, this sense that something's still missing?

First, let me be clear: in my 20+ years working with older trans adults, I've never seen this depression stem from regret or being "wrong" about their gender. That's not what this is.

There are two main reasons for post-transition emptiness:

1. You completed the external work but skipped the internal work. You changed your body, your name, your documents—all crucial. But you didn't detox internalized transphobia. You didn't work through shame and guilt from decades of dysphoria. You didn't address codependency patterns or fear of abandonment. You're now externally aligned with your gender but internally tearing yourself apart.

2. You're viewing everything in life through a trans identity lens. Not every challenge happens because you're trans. Someone cutting you off in traffic? Not about being trans. Getting passed over for something? Maybe it's not about being trans. When you see yourself primarily as a victim of your trans history rather than a whole person with multiple facets, you trap yourself in a "not enough" narrative.

The internal work is hard. Resources are scarce. But it's possible—and necessary for the joy you're seeking.