When I, Kali Cyrus was 17 years old, I really did not want to be gay. I did not want to have a crush on my basketball teammate like I did. I wore heels and skirts out to parties, hoping they would disguise my tomboyish mannerisms. I truly believed I would be alone forever.

Fast-forward to a few days ago when I celebrated my 37th birthday with a group of friends who are diverse in race, profession, and sexual orientation, and who were invited by my fiancé, the most brilliant and beautiful woman I know. Moments like this one remind me that it does, and it did, get better.

For context, I am a Black, queer, masculine-presenting cis female who works as a psychiatrist. I am living my “dream,” technically. Yet, I continue to struggle with severe anxiety and depression despite consistent treatment with medication and therapy for over a decade. In fact, one of the reasons I decided to become a psychiatrist in the first place was to better understand my anxiety, which first manifested in high school in the form of panic attacks.


Not-so-typical coming of age experiences

My reflections come on the heels of the results from The Trevor Project’s third annual National Survey on LGBTQ Youth Mental Health. For those of you who may not know much about The Trevor Project, it’s a nonprofit focused on suicide prevention for lesbian, gay, bisexual, transgender, queer, and questioning youth through 24/7 crisis services platforms.

As a psychiatrist, the results of this year’s report are unfortunately not surprising, but still deeply disturbing. Out of the nearly 35,000 LGBTQ youth who were surveyed, 42 percent of respondents between the ages of 13 and 24 had seriously considered attempting suicide within the past 12 months, with more than half identifying as trans or nonbinary youth.

Looking closer at the data, values were higher for those ages 13 to 17, the age range we label “adolescence.” When most of us think about adolescence, we probably think about typical teenage angst centred around getting good grades, managing bad acne, or whether your crush likes you back.

For mental health professionals, adolescence represents a period where individuals try to solidify who they are, what they believe in, and what they want. What The Trevor Project report shows is that LGBTQ adolescents are not only grappling with typical teenage concerns, but also relentless bullying at school and, for some, where they will find their next meal.

For example, an HRC Foundation analysis of the CDC’s 2019 Youth Risk Behavior Survey shows that 29 percent of transgender youth have been threatened with a weapon on school property. Data from The Trevor Project suggests that 30 percent of LGBTQ youth experienced food insecurity in the past month and that 1 in 4 will experience housing instability at some point in their life.

These numbers paint a much different picture of adolescence for LGBTQ youth and provide for additional worries like whether they want to stay alive.

This is not to say that “typical” adolescent concerns are not distressing as well. However, from my own experience and that of patients, I know how hard it can be to manage both traditional psychosocial dilemmas and intersectional identities.

While my panic attacks in high school may have been triggered by exams, college applications, and a perceived lack of time due to extracurricular activities, my chronic anxiety was kept alive by worrying about how I fit in among my peers as a Black closeted lesbian. I spent so much of my emotional energy on edge, worried that my actions would betray my secret to those around me.

At school, classmates questioned my acceptance to Stanford, citing my race rather than my intelligence as the major admission factor. At home, in West Palm Beach, Florida, where religious values were at the forefront like girls put my soul in jeopardy of going to hell.

The Trevor Project results suggest concerns like mine are common for LGBTQ youth in general. For example, half of the respondents reported discrimination based on their race/ethnicity in the past year, and only 1 out of 3 found their homes to be LGBTQ-affirming.

I see similar themes in my work with patients with depression in their 20s or 30s related to mental health struggles that began in their youth. They recall stories about not fitting into their racial communities or feeling undesirable as genderqueer teens.

Their experiences correlate with The Trevor Project findings that in the two weeks preceding the survey, 72 percent of LGBTQ youth reported symptoms of generalized anxiety and 62 percent reported symptoms of major depressive disorder.