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Content Warning

This article mentions suicide, anxiety, depression, and feelings of hopelessness.

If you’re thinking of hurting yourself or are having suicidal thoughts, please call the National Suicide Prevention Lifeline at 800-273-8255.

You can also call 911 in the case of a mental health emergency.

Tony Ferraiolo lived as a lesbian woman for years. But he never felt right in his body.

“For a very long time, [my life] was filled with depression, anxiety, a suicide attempt, suicidal ideation, and self-harm,” Ferriolo says. “It was a pretty dark journey.”

One night, a friend and bandmate brought over a DVD of “Gendernauts,” a 1999 documentary about people assigned female at birth transitioning to men.

“It showed trans men on a beach, and one of the guys was without a shirt and said, ‘I had my top surgery,’” Ferraiolo recalls. “I fell back in my chair and said, ‘I’m trans.’ In that second, everything made sense — not being comfortable with my body, not wanting people to touch my body, feeling like I was deformed.”

The moment of clarity didn’t immediately bring peace.

Two days later, Ferriolo went to the beach to attempt suicide. He didn’t see himself happy as a trans man, but he wasn’t OK as a lesbian woman, either. Still, something inside of him told him to stop.

“I realized in that moment that I had the power to create Tony,” Ferraiolo says. “I started thinking about what he would look like, and, more importantly, how he would feel. I didn’t want to be sad and depressed. I wanted to be a person with energy who smiled when I stood up in front of people.”

Today, Tony smiles plenty.

He’s gone on to counsel transgender people as the director of the youth and family program for Connecticut-based Health Care Advocates International.

He also founded the nonprofit Jim Collins Foundation, which provides financial help for people seeking gender-confirming surgeries, and was the subject of the documentary “Self-Made Man.

Too often, a trans person’s story takes a different turn.

A 2020 study conducted in the Netherlands of more than 5,100 trans women and 3,100 trans men indicated the average number of suicides was 3 to 4 times higher in the trans population than in the general population from 2013 to 2017.

A 2022 report suggested that 82 percent of transgender people considered suicide and 40 percent had made an attempt.

Experts say peer support is essential in curbing these numbers, but it can be hard to come by.

There’s a meaningful conversation happening about providing support for trans youth.

In the 2022 report, 86 percent of transgender youth said they experienced suicidality, and 56 percent said they had attempted suicide — higher than the average for trans folks of all ages.

A separate study from 2020 suggested that most people have their first experience of gender dysphoria by age seven, but trans people typically do not begin to socially transition or receive hormone therapy until they are in their 20s.

Suicide is not the only risk.

Trans people are 4 times more likely to experience a mental health condition than cisgender individuals, according to a 2019 health record study of about 60 million people in all 50 U.S. states.

Experts say this data highlights the importance of providing transgender people with tools and support.

“Support systems are everything, whether it’s family, friends, or a therapist,” says Lindsey Schafer, LMSW, a New York-based social worker specializing in gender identity and sexuality. “Having a space to be open [with] how you identify gives you a space to be yourself. If you don’t have a space to express that, you are suppressing yourself.”

But not everyone is accepting. Ferraiolo says his friends felt he turned his back on the lesbian community, and others didn’t believe he was really a man.

“It hurt like hell,” he says. “I made a promise to myself that I would only surround myself with people who would love and honor me … it’s a different world when you surround yourself with people who love and adore you.”

Here’s how to be that person for a transgender or nonbinary friend.

You may be eager to be an ally to a friend, or you may be caught off-guard and unsure what to do next. Here are some expert tips on what to say and do — and what to avoid.

Do: Keep the coming out conversation positive

Ferraiolo says he didn’t choose to have gender dysphoria — he was born that way. But telling friends was nerve-wracking, and he doesn’t want others to experience the same hurt he felt when some friends invalidated his identity.

“I always say that if someone comes out to you as trans, nonbinary, or queer, you should be smiling and saying from your heart energy, ‘Thank you for sharing that with me. Congratulations,’” Ferraiolo says. “It’s a great response because the person sitting in front of you won’t feel judged, shamed, or rejected.”

Don’t: Make it about you

It’s a shift to call a friend a new name or refer to them using different pronouns. They may begin to experiment with different clothing and hairstyles.

Though it’s an adjustment for you, Ferraiolo advises against centering yourself.

“As a friend, if I ask you to call me Tony and use male pronouns, it’s not about you,” Ferraiolo says. “A lot of people will say, ‘That’s hard for me … I’ve been calling him Kerri for years.’ Shift from need to want. Say, ‘I want to support my friend,’ and it’ll be an easy transition.”

Erik Dmitriy Palatnik, a life coach, hypnotherapist, and trans man, suggests people avoid comparing their struggles as members of a different oppressed group.

For example, cisgender women should refrain from saying, “I know what it’s like to experience dirty looks when walking down the street.”

“Everybody’s journey is different, and every community is different,” Palatnik says. “Even though you may have the same kind of feelings or challenges, you must always, as a listener who does not belong to a community, refrain from saying, ‘I absolutely know what you are talking about.’”

Instead, Palatnik suggests centering your friend.

“The best thing to do is to really listen and ask what it feels like and validate their feelings,” he says. “If they say it’s painful, validate their pain. Never judge or compare.”

Do: Listen before you talk

When a friend tells you their gender identity, you may immediately have questions. Wait to ask them.

“If you keep interrupting to ask questions, they are not getting out what they need to say to you,” Schafer says. “A lot of people who I’ve worked with often write a script before coming out and memorize it in their head or call someone and talk with them about it. It’s important to open the floor and give them the space.”

Do: Use pronouns

If a person is transitioning, they may wish to be referred to by different pronouns. Ferraiolo says using them is one of the easiest ways to validate and support a person’s identity.

“Even for adults, sometimes the only thing trans or nonbinary people have control over [is pronouns],” he says. “They don’t have control over whether they can afford a surgery. They don’t have control … over whether their families are rejecting them.”

Adding pronouns to your Slack profile, social media bios, and email signatures is another simple way to show support.

“Don’t expect trans and nonbinary people to do all the heavy lifting for normalizing the gender spectrum,” says Grace O’Connor, MA, AMFT of Westwind Recovery in Los Angeles and a trans woman. “[When cisgender people put pronouns in profiles and signatures], it normalizes that people are exploring their gender … we all need to create space for gender. It’s a big thing.”

Do: Treat your friend as an individual

A 2021 PEW Report indicated that 4 in 10 adults know a transgender person or someone who uses gender-neutral pronouns, up 5 percent from 2017.

You may already know a trans or nonbinary person when another friend comes out to you. But Palatnik says it’s important to remember that each person’s journey is different.

Some may have known for years, while others recently came to the realization. Some may be comfortable answering questions or addressing topics others would prefer to avoid. Refrain from making assumptions based on someone else’s experiences or preferences.

“It doesn’t matter how many people who are transgender I’ve encountered,” Palatnik says. “[Every] story is unique.”

Do: Know when to lean in and when to step back

If someone makes an offensive comment about your friend in front of them, you may get emotional. You also may think it’s important to defend the person.

Ferraiolo suggests checking in with the person first to see how they’d like to proceed. He often prefers his friends to ignore the person.

“You can be an ally or super-duper ally,” he says. “A super-duper ally knows when not to step in front of the person they are being an ally for.”

Before going out, Ferraiolo suggests asking, “If something should happen, do you want me to intervene?”

Don’t: Push for answers

Not every transgender or nonbinary person is an open book. They may want certain details to remain private. Schafer advises respecting those boundaries.

“If you push someone, it may make them uncomfortable, close off, or be triggered,” she says.

Don’t: Ask about genitals

One big topic that trans folks say is always off-limits is a person’s genitals and whether they will undergo hormone therapy and gender-confirming surgery.

“That’s none of their concern,” Palatnik says. “It’s so private and intimate.”

Palatnik says a person may not be able to afford surgery or therapy, and the question could be upsetting. Others may simply not want to, but they don’t owe an explanation. Schafer reminds people that genitals correspond to sex, which is different than gender.

“Sex is based on biology, and gender is actually a social construct,” Schafer says. “People have the ability to decide the gender they feel most comfortable with. We are born with a sex, but that does not make you a man or a woman.”

Instead of prying about treatments and surgeries, Ferraiolo recommends asking, “How is your gender journey going?”

“Give them space to share what they want,” he says.

Do: Be aware of your biases

Perhaps your friend came out to you, and you interjected or said something that made them feel invalidated.

Though Schafer does believe it’s important not to make the conversation about you, she understands everyone is human.

“It can throw someone off guard,” she says. “I think it’s important to normalize that if someone tells you their gender identity, you may be a little surprised and uncomfortable.”

And Ferraiolo says words aren’t the only thing that can hurt. Even body language or eye-rolling can be unsupportive to a person discussing their gender journey.

“If your friend comes out to you and you can’t [be happy or supportive], say, ‘Thank you for sharing,’ and start educating yourself about the community,” he says.

Organizations like PFLAG offer support for allies.

Do: Your own research

Even if you reacted well to the news of a person’s gender identity, you might still have questions. Remember, a trans or nonbinary person may not want to answer them.

“Don’t expect trans or nonbinary people to educate you,” O’Connor says. “It’s a lot of heavy lifting. Our experiences are exclusive to our community, and there is not a lot of understanding about it yet. When I share something with a friend who has done their own research, they are affirming me and my experience.”

Good places to start include:

Do: Check in often

The stats are alarming — trans individuals are dying by and attempting suicide and experiencing mental health issues at a higher rate than the cisgender population.

Ferraiolo says it’s essential to check in on your trans and nonbinary friends. They may not be OK.

“If you know somebody who is suffering, ask them, ‘How are you doing?’” Ferraiolo suggests. “And if they break down in front of you crying, do not say, ‘It’s going to be OK. Stop crying.’”

Instead, give them space to not be OK.

“I say, ‘I am sorry you are suffering. What do you need? I am here for you,’” Ferraiolo says. “One supportive adult in a person’s life can end a person’s suicidal thoughts.”

While friends can make a huge difference in a trans or nonbinary person’s life, it’s not your job to save them. But you can offer resources to help them get the help they deserve, including Trans Lifeline and the National Suicide Prevention Lifeline (800-273-8255).

Do: Stand up for your friend and gender nonconforming people when they aren’t around

Defending a friend in front of them can be a welcome action. But gender nonconforming individuals advise cisgender allies not to be complicit when they aren’t present.

Ferraiolo says that when he says something to cisgender individuals, they often think he simply has an agenda to “turn everyone trans.” It’s more impactful when another cisgender person says it — though how they say it is as important as what they say.

“I don’t use anger,” Ferraiolo says. “People shut off their ears with anger … We don’t want to yell because most of the time, people just don’t know better. We don’t want to be mean about it. We want to be kind.”

For example, if someone was wearing a suit one day and a dress the next and a co-worker makes a comment, Ferraiolo suggests saying, “Yeah, maybe they were wearing a dress yesterday, but we are going to honor who they are today.”

Do: Remember gender is a spectrum — and a journey

A person may come out as a trans woman and begin wearing skirts and dresses but then decide that’s not for her. Pronouns may change daily. Experts share it’s important to respect that and not expect a person’s gender identity choices to be definitive or final.

“Ask, ‘What should I call you today? What are your preferred pronouns today?’” Palatnik suggests.

Don’t: Make a person’s gender identity the only topic you discuss

A transition and gender exploration may be a big part of a person’s life and story, but it’s not their entire identity.

“Transgender people are people,” Palatnik says. “A transgender person also has hobbies, a job, and issues unrelated to their identity. It may become tiring [to always talk about being transgender].”

Transgender people can often face ridicule, alienation, and denial of their gender identity. Listening, providing resources, and researching how you can be a better ally can help the transgender folks in your life feel loved and validated.

Understand that gender is a spectrum, and a person may change their pronouns or identity as they get to know themselves better. Let your friend know you love and respect them regardless of where they are on their journey.

While it isn’t always easy to question, explore, and express your gender identity, supportive, loving friends can make all the difference in the world.