Alexithymia in Transgender and Gender-Diverse People: A Scoping Review of an Emerging Field
DOI:
https://doi.org/10.12923/2353-8627/2026-0004Keywords:
alexithymia, gender, mental health, non-binary, transgenderAbstract
Introduction: Alexithymia is a multidimensional psychological construct, acting as a personality trait marked by difficulties in identifying and expressing one’s own emotions. Recent research demonstrates that approximately 8–30% of the global population experience alexithymia, with higher rates among males than females. Studies on alexithymia in transgender and gender-diverse individuals remain limited, creating a significant gap in understanding of the prevalence and impact of alexithymia in these groups. The present scoping review aimed (1) to map existing research on the prevalence of alexithymia in transgender and gender-diverse individuals, and (2) to provide an overview of the role of alexithymia in the biopsychosocial functioning of both transgender and gender-diverse adolescents and adults.
Materials and methods: The following databases EBSCO, MEDLINE, PubMed, Scopus and Web of Science have been searched to locate pertinent studies on alexithymia in transgender and gender-diverse populations. This review was preregistered (INPLASY202530004). No funding is associated with this research.
Results: The findings reveal a very limited body of research on alexithymia in transgender and gender-diverse individuals, though evidence suggests that alexithymia may increase vulnerability to emotion-based psychopathologies (e.g., anxiety).
Conclusions: Addressing alexithymia in transgender and gender-diverse populations may improve mental health assessment and support, potentially enhancing gender-affirming care. More targeted research is needed to develop inclusive and effective interventions.
References
1. Taylor GJ, Porcelli P, Bagby RM. Alexithymia: A defense of the original conceptualization of the construct and a critique of the attention-appraisal model. Clin Neuropsychiatry. 2024;21(5):329-357.
2. Nemiah JC, Sifneos PE. Psychosomatic illness: a problem in communication. Psychother Psychosom. 1970;18(1):154-160.
3. Luminet O, Nielson KA. Alexithymia: Toward an Experimental, Processual Affective Science with Effective Interventions. Annu Rev Psychol. 2025;76(1):741-769.
4. Preece DA, Mehta A, Becerra R, Chen W, Allan A, Robinson K, et al. Why is alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation. J Affect Disord. 2022;296:337-341.
5. Taylor GJ, Bagby RM, Parker JD. Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge; Cambridge University Press: 1999.
6. Preece DA, Mehta A, Petrova K, Sikka P, Pemberton E, Gross JJ. Alexithymia profiles and depression, anxiety, and stress. J Affect Disord. 2024;357:116-125.
7. Honkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinamäki H. Depression is strongly associated with alexithymia in the general population. J Psychosom Res. 2000;48(1):99-104.
8. Mendia J, Zumeta LN, Cusi O, Pascual A, Alonso-Arbiol I, Díaz V, et al. Gender differences in alexithymia: Insights from an updated meta-analysis. Pers Individ Dif. 2024;227:112710.
9. Ard KL, MacDonald-Ly A, Demidont AC. Sexual health care for transgender and gender diverse people. Med Clin North Am. 2024;108(2):393-402.
10. Di Benedetto L, Pinto M, Ieritano V, Lisci FM, Monti L, Marconi E, et al. Gender Differences in Alexithymia, Emotion Regulation, and Impulsivity in Young Individuals with Mood Disorders. J Clin Med. 2025;14(6):2030.
11. Levant RF., Hall RJ, Williams CM, Hasan NT. Gender differences in alexithymia. Psychol Men Masc. 2009;10(3):190-203.
12. Kaufman MR, Eschliman EL, Karver TS. Differentiating sex and gender in health research to achieve gender equity. Bull World Health Organ. 2023;101(10):666-671.
13. White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222-231.
14. Thorne N, Yip AK, Bouman WP, Marshall E, Arcelus J. The terminology of identities between, outside and beyond the gender binary - A systematic review. Int J Transgend. 2019;20(2-3):138-154.
15. Nolan BJ, Cheung AS. Gender-affirming hormone therapy for transgender and gender-diverse adults in Australia. Intern Med J. 2024;54(9):1450-1457.
16. National Academies of Sciences, Engineering, and Medicine. Sex and gender identification and implications for disability evaluation. Washington (DC); National Academies Press: 2024.
17. Turban J.L, Loo SS, Almazan AN, Keuroghlian AS. Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT Health. 2021;8(4):273-280.
18. Mezza F, Mezzalira S, Pizzo R, Maldonato NM, Bochicchio V, Scandurra C. Minority stress and mental health in European transgender and gender diverse people: A systematic review of quantitative studies. Clin Psychol Rev. 2024;107:102358.
19. Shelemy L, Cotton S, Crane C, Knight M. Systematic review of prospective adult mental health outcomes following affirmative interventions for gender dysphoria. Int J Transgend Health. 2024;26(3):480-500.
20. Hajek A, König HH, Buczak-Stec E, Blessmann M, Grupp K. Prevalence and Determinants of Depressive and Anxiety Symptoms among Transgender People: Results of a Survey. Healthcare. 2023;11(5):705.
21. Salokangas RKR, From T, Salokangas H.R.W, Lehtoranta L, Suvisaari J, Koskinen S, et al. Effects of childhood adversities on alexithymia features vary between sexes: Results of a prospective population study. Eur J Psychotraumatol. 2024;15(1):2407256.
22. Zdankiewicz-Ścigała E, Ścigała DK. Attachment style, early childhood trauma, alexithymia, and dissociation among persons addicted to alcohol: Structural equation model of dependencies. Front Psychol. 2020;10:2957.
23. Ramos N, Marr MC. Traumatic stress and resilience among transgender and gender diverse youth. Child Adolesc Psychiatr Clin N Am. 2023;32(4):667-682.
24. Wittlin NM, Kuper LE, Olson KR. Mental health of transgender and gender diverse youth. Annu Rev Clin Psychol. 2023;19:207-232.
25. Denning DM, Brown TA. Examining the prospective effects of alexithymia and minority stress on emotion regulation in sexual minority adults. Affect Sci. 2024;6(2):236-242.
26. Singh A, Dandona A, Sharma V, Zaidi SZH. Minority stress in emotion suppression and mental distress among sexual and gender minorities: A systematic review. Ann Neurosci. 2023;30(1):54-69.
27. Kallitsounaki A, Williams DM. Brief report: An exploration of alexithymia in autistic and nonautistic transgender adults. Autism Adulthood. 2023;5(2):210-216.
28. Mazzoli F, Cassioli E, Ristori J, Castellini G, Rossi E, Cocchetti C, et al. Apparent autistic traits in transgender people: A prospective study of the impact of gender-affirming hormonal treatment. J Endocrinol Invest. 2022;45(11):2059-2068.
29. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473.
30. Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23-32.
31. Preece D, Becerra R, Robinson K, Dandy J, Allan A. The psychometric assessment of alexithymia: Development and validation of the Perth Alexithymia Questionnaire. Pers Individ Dif. 2018;132:32-44.
32. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev. 2022;18:e1230.
33. Larionow P, Preece DA, Mudło-Głagolska K. The Polish version of the Perth Alexithymia Questionnaire-Short Form (PAQ-S): Psychometric properties and norms. J Sex Ment Health. 2023;21:54-63.
34. Larionow P, Mudło-Głagolska K, Preece DA. Latent structure and profiles of emotion regulation: Reappraisal and suppression patterns with the Polish version of the Emotion Regulation Questionnaire. J Clin Med. 2025;14(2):587.
35. Skotalczyk MA, Dąbrowska KA, Smorońska-Rypel J, Wilczyński KM, Janas-Kozik M. Alexithymia as a Risk Factor for an Internet Addiction in Adolescents and Young Adults with Autism Spectrum Disorder. Eur J Investig Health Psychol Educ. 2024;14(3):669-684.
36. Ristori J, Cocchetti C, Castellini G, Pierdominici M, Cipriani A, Testi D, et al. Hormonal treatment effect on sexual distress in transgender persons: 2-year follow-up data. J Sex Med. 2020;17(1):142-151.
37. Reed MB, Handschuh PA, Klöbl M, Konadu ME, Kaufmann U, Hahn A, et al. The influence of sex steroid treatment on insular connectivity in gender dysphoria. Psychoneuroendocrinology. 2023;155:106336.
38. Hamel C, Rodrigue C, Clermont C, Hébert M, Paquette L, Dion J. Alexithymia as a mediator of the associations between child maltreatment and internalizing and externalizing behaviors in adolescence. Sci Rep. 2024;14:6359.
39. Cheung AS, Cook T, Ginger A, Zwickl S. Sex specific reference ranges and transgender care. BMJ. 2022;376:e069874.
40. Doyle DM, Lewis TOG, Barreto M. A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people. Nat Hum Behav. 2023;7:1320-1331.
41. Tordoff DM, Wanta JW, Collin A, Stepney C, Inwards-Breland DJ, Ahrens K. Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Netw Open. 2022;5(2):e220978.
42. Chen D, Berona J, Chan YM, Ehrensaft D, Garofalo R, Hidalgo MA, et al. Psychosocial Functioning in Transgender Youth after 2 Years of Hormones. N Engl J Med. 2023;388(3):240-250.
43. Mazur M, Larionow P. The Effects of Gender-Affirming Hormone Therapy on Quality of Life: The Importance of Research on Youth. Healthcare. 2024;12(13):1336.
44. Larionow P, Mazur M. The importance of increasing the visibility of gender identity in research. J Sex Ment Health. 2024;22:50-51.
45. Lam JSH, Abramovich A, Victor JC, Zaheer J, Kurdyak P. Characteristics of Transgender Individuals With Emergency Department Visits and Hospitalizations for Mental Health. Psychiatr Serv. 2022;73(7):722-729.
46. Bagby RM, Parker JD.A, Taylor GJ. Twenty-five years with the 20-item Toronto Alexithymia Scale. J Psychosom Res. 2020;131:109940.
47. Zahid A, Taylor GJ, Lau SCL., Stone S, Bagby RM. Examining the Incremental Validity of the Perth Alexithymia Questionnaire (PAQ) Relative to the 20-Item Toronto Alexithymia Scale (TAS-20). J Pers Assess. 2023;106(2):242-253.
48. Preece DA, Mehta A, Petrova K, Sikka P, Bjureberg J, Chen W, et al. The Perth Alexithymia Questionnaire-Short Form (PAQ-S): A 6-item measure of alexithymia. J Affect Disord. 2023;325:493-501.
49. Winefield HR, Gill TK, Taylor AW, Pilkington RM. Psychological well-being and psychological distress: is it necessary to measure both? Psychol Well Being. 2012;2:3. doi:10.1186/2211-1522-2-3.
50. Sgherza TR, Becerra R, Naragon-Gainey K. Internalising symptoms and wellbeing: Meta-analysis of the potential protective role of psychological strengths and interpersonal resources. J Affect Disord. 2025;390:119809. doi:10.1016/j.jad.2025.119809.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
