Panic Attacks

I used to get three or four panic attacks a year before I transitioned but after I transitioned they dropped to one. I joke about that one, it was during writing my capstone paper for my masters degree, other than that one they have all disappeared.

I am a member of WPATH (World Professional Association for Transgender Health) and I just got a batch of their journals for last year. One research study caught my attention…

Transgender and anxiety: A comparative study between transgender people and the general population
INTERNATIONAL JOURNAL OF TRANSGENDERISM
2017, VOL. 18, NO. 1, 16–26
By Walter Pierre Bouman, Laurence Claes, Nicky Brewin, John R. Crawford, Nessa Millet, Fernando Fernandez-Aranda & Jon Arcelus

ABSTRACT

Background: Anxiety disorders pose serious public health problems. The data available on anxiety disorders in the transgender population is limited by the small numbers, the lack of a matched controlled population and the selection of a nonhomogenous group of transgender people.

Aims: The aims of the study were (1) to determine anxiety symptomatology (based on the HADS) in a nontreated transgender population and to compare it to a general population sample matched by age and gender; (2) to investigate the predictive role of specific variables, including experienced gender, self-esteem, victimization, social support, interpersonal functioning, and cross-sex hormone use regarding levels of anxiety symptomatology; and (3) to investigate differences in anxiety symptomatology between transgender people on cross-sex hormone treatment and not on hormone treatment.
[…]
Results: Compared with the general population transgender people had a nearly threefold increased risk of probable anxiety disorder (all p < .05). Low self-esteem and interpersonal functioning were found to be significant predictors of anxiety symptoms. Trans women on treatment with cross-sex hormones were found to have lower levels of anxiety disorder symptomatology.

Conclusions: Transgender people (particularly trans males) have higher levels of anxiety symptoms suggestive of possible anxiety disorders compared to the general population. The findings that self-esteem, interpersonal functioning, and hormone treatment are associated with lower levels of anxiety symptoms indicate the need for clinical interventions targeting self-esteem and interpersonal difficulties and highlight the importance of quick access to transgender health services.

For me the stress of living two lives and keeping them separate created the panic attacks and once that stress was removed the anxiety attacks disappeared.

They also found that Cross-sex Hormone Treatment (CHT) had an effect on anxiety disorders,

Comparison between people on CHT and those not on CHT
Analyses comparing transgender people on CHT with those not on CHT found a statistically significant difference between both groups with more transgender people using CHT in the category of no anxiety disorder compared to those on not on CHT [x2 (1) D 20,266, p < .001].
…The new analyses showed that for trans females, being on CHT was associated with less anxiety disorder as there were more trans females not on CHT in the category of anxiety disorders compared to trans females on CHT [x2 (1) D 21,802, p < .001]. This was not the case for trans males [x2 (1) D 1,379, p < .240].

This was true for me, once I started taking CHT the number of my panic attacks decreased.

In the discussion they said,

Compared with a cisgender matched control group from the general population, transgender people had an almost threefold increased risk of probable anxiety disorder. Trans males showed higher rates of possible and probable anxiety disorder (71.1%) than trans females (59.8%), which is in keeping with the literature on gender differences in anxiety disorders, if the pattern of birth gender is followed (McLean et al., 2011).
[…]
Further findings confirmed the benefits of cross-sex hormone treatment, particularly for trans women on CHT, as they were significantly more prevalent in the category "No Anxiety Disorder" compared to those who do not use cross-sex hormones. That these findings do not apply to trans men is surprising, and certainly do not reflect our clinical experience. One explanation may be that the higher risk of developing anxiety disorder for people whose sex was assigned female birth offsets the positive psychological benefits of CHT in trans men. This specific area needs further study. The findings confirm existing research (Bouman et al., 2016; Colizzi et al., 2014; De Vries et al., 2014; G omez-Gil et al., 2012; Heylens et al., 2014b) and add further weight to the rationale of early treatment for gender dysphoria.

In many countries, long waiting lists and lack of clinical services for transgender people combined with overly prescriptive pathways to access CHT in standards of care (Coleman et al., 2012; Wylie et al., 2014) continue to be significant barriers to treatment for transgender people.

Okay I see a couple of areas that should have been studied; the first is that they should also have looked at how well an individual was able to integrate in to society. I think they would have found that a trans person who can get by in society without being identified as trans would have a lower incidence of panic attacks. The other thing was how much support did they receive from family and friends to see how that would affect their panic attacks.