Depression is one of the most frequently diagnosed psychiatric illnesses, which remains a big cause of mortality and morbidity among all groups of population. 1 Things are not different in our part of the world as depression remains a common mental health illness in our population. 2 If untreated, it may lead to serious consequences including severe depression with psychotic illness, physical problems and even suicide. [3][4][5] Transgender is a broad term which includes the people with all types of gender identity disorder. ICD-11 coins a new term for this group of people, i.e. gender incongruence. In United States of America, 390/100,000 individuals are believed to be transgenders. 6 Census of 2017 has shown that more than 10,000 transgender subjects exist in Pakistan. They suffer from various health issues including the HIV, drug dependence, and various mental health problems. 7,8 Previous research highlights the presence of depression and suicide ideation among the transgender population. Depression, suicide and other mental health indices are very high among the transgender population as compared to controls even in a developed country like USA. 9 Another study showed suicide attempt rate as 32-50% among the transgender population of our neighboring country India. This was also coupled with increased rate of depression among the target population. 10 Oswalt et al. concluded in a large study that all mental health illnesses including schizophrenia are found more among the transgender as compared to heterosexual controls. 11 Depression and suicidal ideation, if remain unaddressed for long, may result in poor life quality and even leading to death. 12 Suicidality and depression have some common biological pathways, which explain one of the bases of their comorbidity. Role of genetics, alteration in the hypothalamic-pituitary-adrenal (HPA) axis, dysregulation of serotonin metabolism and receptors and neuroimmunological basis are some of the factors which contribute in development of both depression and suicidality. 13 In addition to the biological factors, depression also leads to suicidal ideation and suicidality by psychological and social pathways. 14 Ideas of self harm are also part of diagnostic criteria for depression in