Health, Psychosocial Outcomes, and Help-seeking Behaviors Among Transgender Individuals in Urban India: A Mixed-methods Study

Background: Transgender individuals in India face elevated levels of health disparities rooted in social stigma, institutional discrimination, family rejection, and structural exclusion. The study aims to explore factors influencing health, psychosocial outcomes, and help-seeking behavior among transgender individuals in the Bangalore Urban Area. Method: An analytical mixed-methods design, triangulating a quantitative cross-sectional assessment with qualitative thematic analysis. One hundred transgender individuals were recruited purposively via NGO networks and community settings. Instruments included the WHOQOL-BREF, the self-reporting questionnaire (SRQ-20), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Transgender Identity Stigma Questionnaire (TISQ). Ten key stakeholders participated in semi-structured in-depth interviews. Statistical analyses comprised Spearman correlations, Kruskal–Wallis tests with Bonferroni post hoc corrections, and one-way ANOVA, with thematic analysis used for qualitative data. Results: Moderate-to-high psychological distress was found in 35.4% of trans women and 33.3% of trans men. Felt normative stigma was higher than enacted stigma (Mean 24.79 vs. 13.58). Overall quality of life was moderate, with social relationships highest and physical health the lowest. Social support was significantly positively associated with all WHOQOL-BREF domains ( r = 0.56, p < .01); mental distress negatively predicted all QoL domains. Family support significantly predicted psychological ( H = 20.95, p < .001) and environmental QoL ( H = 18.60, p < .001). Conclusions: Stigma, economic marginalization, and institutional mistrust collectively undermine mental health and quality of life. Peer networks and NGOs serve as primary protective and help-seeking conduits. Gender-affirming healthcare reforms, mandatory provider sensitization, and sustained community-led support are urgently needed.