Cannabis Use Was Strongly Linked to Social Anxiety Among People With Gender Dysphoria | Research

The takeaway

In a Spanish clinical sample of 210 individuals with gender dysphoria, 31.4% had social anxiety disorder, and current cannabis use was one of the strongest associated factors with a nearly 4-fold increased odds.

Readers interested in mental health among transgender and gender-diverse individuals, and the relationship between cannabis and anxiety.

Current cannabis use associated with 3.87x odds of social anxiety disorder

What the researchers found

Researchers studied social anxiety among 210 individuals attending a public gender identity unit in Spain. The prevalence of social anxiety disorder was 31.4%, substantially higher than general population estimates.

In multivariable analysis, the strongest predictors of social anxiety disorder were depression score and current cannabis use, which was associated with nearly 4-fold increased odds of social anxiety (OR = 3.873). Other associated factors included younger age, hospitalization of parents during childhood, and nationality.

Social anxiety was also significantly associated with lifetime suicidal ideation, non-suicidal self-injury, perceived school violence during childhood, and unemployment.

Why it matters

The high rate of social anxiety in this population highlights an underrecognized mental health burden. The strong association with cannabis use raises questions about whether individuals with gender dysphoria and social anxiety may use cannabis as self-medication, or whether cannabis use exacerbates social anxiety in this vulnerable group.

The numbers in context

210 participants (48% trans female, 52% trans male). 31.4% had social anxiety disorder. Cannabis use: OR = 3.873 for social anxiety. Depression: OR = 1.083 per BDI point. Lifetime suicidal ideation: RR = 1.902.

How the study worked

A cross-sectional study of 210 individuals (48% trans female, 52% trans male) attending a public gender identity unit in Spain. Social anxiety was diagnosed using the Mini-International Neuropsychiatric Interview. Multiple validated instruments assessed depression, violence exposure, and social support.

What this study cannot tell us

The cross-sectional design cannot determine whether cannabis use contributes to social anxiety or whether socially anxious individuals are more likely to use cannabis. The sample came from a single clinic in Spain and may not represent all individuals with gender dysphoria. The study assessed current cannabis use without measuring frequency or amount.

How to read the evidence

This is a cross-sectional study from a single clinical sample. It identifies a strong association but cannot determine directionality or causation.

When this study was published

Published in 2016. Research on mental health and substance use among gender-diverse populations has expanded significantly since then.

The bigger picture

This study highlights the intersection of gender identity, mental health, and substance use. People with gender dysphoria face elevated rates of discrimination, violence, and psychological distress, all of which contribute to both anxiety and substance use. Understanding these interconnections is important for providing appropriate care.

Questions still open

Does cannabis reduce or worsen social anxiety in people with gender dysphoria? Would targeted anxiety treatment reduce cannabis use in this population?

Common questions

Does cannabis cause social anxiety?

This study found a strong association but cannot determine cause and effect. It is possible that people with social anxiety use cannabis to cope, that cannabis worsens existing anxiety, or that both are driven by a shared underlying factor like minority stress.

Why is social anxiety so common among people with gender dysphoria?

Social anxiety in this population likely reflects multiple factors including experiences of discrimination, stigma, violence, and social rejection. The 31.4% rate found here is much higher than the general population estimate of 7-12%.

Read the original research

Gender Dysphoria and Social Anxiety: An Exploratory Study in Spain.

The journal of sexual medicine, 13(8), 1270-8

View on PubMed ↗Publisher’s paper ↗

Citation

Bergero-Miguel, Trinidad; García-Encinas, María A; Villena-Jimena, Amelia; Pérez-Costillas, Lucía; Sánchez-Álvarez, Nicolás; de Diego-Otero, Yolanda; Guzman-Parra, Jose. (2016). Gender Dysphoria and Social Anxiety: An Exploratory Study in Spain.. The journal of sexual medicine, 13(8), 1270-8. https://doi.org/10.1016/j.jsxm.2016.05.009