Research on trans people usually answers a question posed from the outside: what happens to them, what is good for them, what the data say. This paper reverses the direction of that gaze. It is the first “bottom-up” review of the lived experience of trans persons, co-written by experts by experience and academic researchers, and published in World Psychiatry.
The team —coordinated by Paolo Fusar-Poli and Ana Estradé, with more than twenty signatories from very different backgrounds— did not start from hypotheses or scales. It started from first-person narratives. They searched medical and non-medical literature for accounts written by trans people, extracted the themes that kept recurring and appraised them in collaborative workshops, using a cloud-based system to share and review the material. The result is four broad themes that organise what these people say about themselves.
An identity that does not always arrive clearly
The first theme describes the diversity of identities: some people identify as men or as women, some simultaneously as both, and others place themselves in other categories or in a fluid gender. The narratives share a frequent starting point: the experience of an uncertain identity and the feeling of being in the wrong body, with some degree of mind-body disconnection. But the paper highlights what often stays out of the clinical account: many trans people feel satisfied with their body and with their identity.
Affirmation: work on oneself
The second theme deals with gender affirmation, framed as a process of bodily and mental redefinition of the self. The authors report an uncomfortable and rarely cited nuance: it sometimes involves fighting oneself to accept one’s own identity. Affirmation includes changes in the body to communicate the lived identity as well as behavioural changes, and it comes with a strong emotional impact: the restoration of a sense of self and an intense emotional reaction to gender-affirming care. In a few cases, the narratives describe a decision to stop or reverse that process.
The weight of the social context
The third theme describes the social journey: an initial attempt to hide one’s identity, then coming out to others and wanting to be recognised in the lived gender. The narratives share high exposure to transphobia, institutional discrimination and violence: being treated as someone wrong or dehumanised, pressure to “pass” as a man or a woman, the use of a name or pronouns that do not correspond, and verbal microaggressions. Family appears in two opposite versions —a source of conflict or a safe base— and the same happens with friends and partners, who can be a place of rejection or of resilience and repair.
Asking for help and receiving care
The fourth theme addresses health care. The experience can be one of feeling rejected, devalued or objectified, but also one of feeling validated and cared for. Trans people sometimes describe getting lost in the maze of gender-affirming services, or living the diagnostic assessment as a difficult test; others speak of relief. Mental health care generates ambivalence: fear of being exposed and of it working as a gatekeeper for gender-affirming care, or else a restorative and genuinely healing experience.
Why it matters
The authors themselves place the value of the work on educational and social ground: it helps guide medical and psychological practice, research and public health policy, and supports anti-discrimination measures. It is, in short, an exercise in structured listening: putting first-person experience at the centre of a subject that has almost always been written about from the outside.
Source: The lived experience of trans persons: a bottom-up review co-written by experts by experience and academics. Fusar-Poli P, Estradé A, Rosfort R, et al. World Psychiatry 2026;25(3):359-381. DOI: 10.1002/wps.70080.
Read the publication: World Psychiatry.
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