Yet most trans adults say transitioning has made them more satisfied with their lives.

“Living doesn’t hurt anymore,” said TC Caldwell, a 37-year-old Black nonbinary person from Montgomery, Ala. “It feels good to just breathe and be myself.”

Josie Caballero, the director of the National Center for Transgender Equality’s U.S. Trans Survey and a trans woman herself, said polls like it and the Post-KFF survey “provide critical tools for researchers, policymakers and advocates seeking to better understand the needs of transgender people to find ways to improve their lives.”

Other studies have shown that the trans community has grown to an estimated 1.3 million adults, and surveys by the Centers for Disease Control and Prevention find that the trans adult population is younger than the cisgender adult population at large. Most trans adults are younger than 35 years old.

The Post-KFF survey finds that trans adults hold widely different ideas about what it means to transition. While most trans people have socially transitioned, meaning they’ve changed their clothing, names or pronouns, far fewer have medically transitioned. Less than a third have used hormone treatments or puberty blockers, and about 1 in 6 have undergone gender-affirming surgery or other surgical treatment to change their physical appearance.

A 62 percent majority of trans adults identify as “trans, gender non-conforming” or “trans, non-binary,” while 33 percent identify as a “trans man” or “trans woman.” Nearly half ask people to refer to them with they/them pronouns, although most say they sometimes use she/her or he/him pronouns.

“I think there’s a pushback against this idea that we have to fit in one of those boxes,” said Josie Nixon, a 30-year-old nonbinary person who lives in Denver. “There are certainly binary trans men and women who fit well in those boxes and love being there, but I think there is a trend, especially as more young people find themselves, to say, ‘These boxes don’t do me justice, and they don’t represent me in a way that encompasses all of who I am, so I’d rather exist in between or outside those boxes.’”

Most trans adults say they knew when they were young that their gender identity was different from the sex they were assigned at birth. About a third (32 percent) say they began to understand their own gender identity when they were 10 or younger, and another third (34 percent) realized it between the ages of 11 and 17.

Alyssa Rogers, a White 26-year-old trans woman who lives in Austin, said she first knew when she was around 5 years old. Her mother had been arrested for drug use, and Rogers was sent to live in an orphanage. While she was there, Rogers tried on a pink princess dress for the first time, and she immediately felt “right.”

“It was the first time I got to do something like that,” Rogers said. “It was nice. I wanted to share it, but I was scared to because I knew it wouldn’t be accepted.”

Rogers eventually moved in with her grandparents, and like other trans people in the Post-KFF survey, she struggled with depression and loneliness in her childhood.

Compared with Americans as a whole, trans adults are more than twice as likely to say they experienced serious mental health problems such as depression or anxiety growing up (78 percent versus 32 percent for the U.S. overall).

Just over half of trans adults say they had a happy childhood (53 percent), but that rate is far lower than the 81 percent of Americans overall who say their childhood was happy.

Most trans people (59 percent) say they lacked a trusted adult to talk to while growing up, including 64 percent of trans people of color. Those who did have a trusted adult were much more likely to report feeling safe in their childhood homes and to have a happy childhood.

School marked one of the greatest stressors for trans children. More than 4 in 10 say they felt unsafe at school, and one-quarter felt unsafe participating in sports or in other youth activities.

Rogers said she was an “outcast” at school, so few classmates commented when she began cross-dressing as a teenager. But her family grew upset, she said. Rogers said her grandparents committed her to a mental hospital and later sent her to conversion therapy in Colorado. The state has since banned the practice, but Rogers’s experience was commonplace. One in 4 trans adults say they attended religious services as a child or teenager that tried to change their sexual orientation or gender identity, and about 1 in 10 say they attended conversion or reparative therapy.

“I definitely thought about killing myself,” Rogers said. “I was in a terrible situation.”

For years, Rogers went to bed hungry, sometimes out of necessity, and sometimes because she believed if she didn’t eat, she wouldn’t grow. If she didn’t grow, she thought, she could pass more easily as a girl.

A few years after Rogers went through conversion therapy, she decided to start taking estrogen. She knew many in her family would reject her once she told them she was a w