Introduction Social anxiety in gender dysphoria is still under investigation. Aim To determine the prevalence and associated factors of social anxiety in a sample of individuals with gender dysphoria. Methods A cross-sectional design was used in a clinical sample attending a public gender identity unit in Spain. The sample consisted of 210 individuals (48% trans female and 52% trans male). Main outcome measures Mini-International Neuropsychiatric Interview (MINI) for diagnosis of social anxiety disorder, Structured Clinical Interview, Exposure to Violence Questionnaire (EVQ), Beck Depression Inventory (BDI-II), and Functional Social Support Questionnaire (Duke-UNC-11). Results Of the total sample, 31.4% had social anxiety disorder. Social anxiety disorder was highly correlated with age (r = −0.181; CI = 0.061–0.264; P = .009) and depression (r = 0.345; CI = 0.213–0.468; P < .001); it is strongly associated to current cannabis use (relative risk [RR] = 1.251; CI = 1.070–1.463; P = .001) and lifetime suicidal ideation (RR = 1.902; CI 1.286–2.814; P < .001). Moreover, it is significantly associated to lifetime nonsuicidal self-injury (RR = 1.188; CI 1.018–1.386; P = .011), nationality (RR = 7.792; CI 1.059–57.392; P = .013), perceived violence at school during childhood and adolescence (r = 0.169; CI = 0.036–0.303; P = .014), unemployment (RR = 1.333; CI 1.02–1.742; P = .021), and hospitalization of parents in childhood (RR = 1.146; CI = 1.003–4.419; P = .046). Using multivariable analysis, the highly significant variables within the model were depression score (odds ratio [OR] = 1.083; CI = 1.045–1.123; P < .001) and current cannabis use (OR = 3.873; CI = 1.534–9.779, P = .004), also age (OR = 0.948; CI = 0.909–0.989; P = .012), hospitalization of parents during childhood (OR = 2.618; CI = 1.107–6.189; P = .028), and nationality (OR = 9.427; CI = 1.065–83.457; P = .044) were associated with social anxiety disorder. Conclusion This study highlights the necessity of implementing actions to prevent and treat social anxiety in this high-risk population.

Transsexuals' levels of anxiety and cannabis/cocaine use are comparable to those in the general population. Cannabis may be used to control anxiety and can have detrimental clinical implications for transsexuals.