Transgender Bathroom Bans are a Growing Public Health Issue

Dylan Thomas Cotter runs through a familiar checklist before leaving his house. He avoids drinking liquids for about an hour beforehand. He times his home bathroom visit to the very last minute. And when he must venture into public restrooms, at 42 years old, he brings his cisgender partner along—an adult using the buddy system because, as he puts it, "cisgender people have made public restrooms for transgender people [...] absolutely dangerous.”

I can see how cisgender people might think of bathroom bans as an inconvenience or a hassle, even when they can acknowledge it as a human rights issue. But it isn’t just our dignity and our immediate safety at risk when lawmakers embolden the average citizen to act as the bathroom police. Bathroom avoidance presents real long-term risks to both our mental and physical health.

Physical Consequences of Transgender Bathroom Bans

Research published in the International Journal of Transgender Health in April 2025 by Myeshia Price et al. reveals the monumental scope of bathroom avoidance among transgender and nonbinary young people, documenting both the prevalence of these kinds of protective actions and their cascading effects on physical and mental health.

The study, which surveyed 12,596 transgender and nonbinary young people aged 13-24, found that 73% reported sometimes or always avoiding public bathrooms in the past year due to safety concerns. Among those avoiding bathrooms, 49% did so sometimes, while 22% avoided them always.

The physical consequences prove immediate and measurable. Among transgender and nonbinary young people, 67% reported "holding it" when they needed to use the bathroom, while 38% avoided drinking or eating to prevent bathroom needs. These behaviors create serious health risks: 10% developed urinary tract infections, 1% experienced kidney infections, and 1% had other kidney-related problems—all directly attributed to bathroom avoidance.

Dr. Syd Young from OutWellness emphasizes the broader health implications: "Holding it too long can irritate the bladder and increase the risk for urinary tract infections, which can become recurrent and quite painful. Chronic constipation is also common because people will delay bowel movements until they’re in a ‘safe’ bathroom. Over time, that can lead to pelvic floor dysfunction—muscles that are either too tense from clenching or too weak from underuse."

The Mental Health Cost of Bathroom Hypervigilance

Dr. Young frames this as structural trauma: "Bathroom bans take a basic human function and turn it into a site of risk. For queer and trans people, bathrooms become places where you have to brace yourself—'Will I be questioned? Will I be harassed? Will I be fined or forced out?' That anticipatory stress wires into the nervous system."

For Charli, a member of the OutWellness community, the risks she faces in bathrooms as a transgender woman were a major factor in her decision to pursue gender-affirming surgery. "The rhetoric around bathroom bans all over the [United States] and even in other countries like the UK have caused me to avoid bathrooms in public," she explains. "It has caused me to have panic attacks, change my travel plans, change where I eat, where I go to the movies, and how I function in day to day life."

“Bathroom avoidance changes how people move through their day,” says Dr. Young. “I’ve had folks tell me they don’t go on hikes, don’t attend community events, or skip the gym entirely because they don’t know if they’ll have safe bathroom access. That’s not just physical—that’s cutting people off from exercise, social connection, and stress relief. So the health consequences are both very concrete—infections, dehydration, digestive issues—and also indirect, limiting people’s ability to take part in wellness activities.”

In the research, transgender and nonbinary young people who reported avoiding public bathrooms showed significantly higher odds of anxiety symptoms (64% higher), depression symptoms (64% higher), and seriously considering suicide (68% higher) compared to peers who never avoided bathrooms. Most alarmingly, those avoiding bathrooms had nearly twice the odds of attempting suicide (95% higher risk).

“In trauma-informed care, we often talk about how trauma isn’t just an event—it’s also the ongoing structures that create environments of fear and disempowerment,” Dr. Young tells me. “Bathroom bans are exactly that. [...] This is what we mean when we say structural trauma: the structure itself—the law, the building, the policy—recreates the conditions of trauma again and again. It’s not just one bad encounter, it’s an environment designed to keep you in fight-or-flight. And because using the restroom is a daily need, the exposure is relentless.”

The Cumulative Burden of Bathroom Bans

Binary transgender young people report the highest rates of bathroom avoidance, with 91% of transgender boys and men and 85% of transgender girls and women avoiding public bathrooms in the past year. Nonbinary young people also show concerning rates: 68% of those assigned female at birth and 62% of those assigned male at birth.

These numbers reflect lives constrained by fear. Cotter explains the mental burden: "Naturally I am now conditioned to be overtly cautious while entering any restroom—men's or family restrooms. Historically, cisgender people have made it so dehumanizing for transgender people to simply relieve themselves in private that many transgender people such as myself now have hypervigilance surrounding what we may or may not have to anticipate safety-wise."

“That cumulative burden shows up in ways providers don’t always connect,” Dr. Young tells me. “A trans client might come in with recurring UTIs, and the provider treats it as a simple infection, without asking: ‘Are you avoiding bathrooms because of safety?’ Or someone’s pelvic floor dysfunction might be framed as purely biomechanical, when in reality it’s tied to trauma and chronic avoidance. If providers don’t make that connection, they miss the root cause.”

Dr. Young wants health and wellness providers to acknowledge the healthcare burden that transgender bathroom bans are causing. “Even saying, ‘I know restroom access can be stressful—how has that been for you?’ opens the door for patients to share. When we acknowledge the cumulative health burden, we’re also better advocates. [...] We can normalize conversations about hydration and elimination in a way that’s shame-free. And we can see our queer and trans patients not as ‘non-compliant’ but as people navigating impossible systems.”

From Survival Strategies to Policy Solutions

For healthcare and wellness professionals, the research demands recognition of bathroom restrictions as a public health crisis. Dr. Young calls for providers to understand the cumulative burden: "Bathroom restrictions don't exist in isolation. They stack on top of every other barrier that queer and trans people already face in healthcare."

The path forward requires both individual and systemic responses. While tactical planning—knowing where single-stall bathrooms are located, timing hydration around safe access—can help individuals cope, the responsibility cannot rest solely on those affected.

“It’s important to acknowledge that coping is not the same as fixing,” says Dr. Young, and they know this from experience. “I absolutely avoid public bathrooms at times,” they tell me. “And I think it’s important to be transparent about that, because it shows this isn’t hypothetical—it’s lived reality. My planning around bathrooms looks like a constant background calculation.”

That constant calculation takes a toll. “The impact is more than just logistical. It’s mental load. It takes energy to always be planning two or three steps ahead for something as basic as peeing. And it limits spontaneity—saying yes to last-minute plans, joining a friend for a long walk, going into new spaces. Instead of living in the moment, you’re constantly running a risk assessment. That’s exhausting. There’s also an emotional toll. [...] You start to notice how much of your life is shaped by fear of a confrontation.”

As the research authors conclude, their findings "demonstrate that implementing inclusive bathroom policies may improve physical and mental health and decrease suicide risk among transgender and nonbinary young people." The data makes clear that bathroom access isn't a frivolous or petty political talking point, isn’t just a “distraction” from “important issues”—it's a matter of basic human dignity and public health.

Yet within this challenging landscape, moments of resistance emerge. Cotter has found a way to leave hope for others: "I do make it a point when I enter a public restroom to leave 'a trans person peed here and no one was harmed' sticker within the stall so maybe that'll be hope for the next trans person who might be in that stall in the future."