209. Perception of Gender And Mental Health In Transgender And Cisgender Adolescents And Young Adults

Abstract

Emerging data suggest that transgender individuals have higher rates of anxiety, depression, tobacco use, and other risk behaviors compared to their cisgender counterparts. Prior research has suggested that stigma associated with transgender identities is a contributing factor. Experiences of adverse experiences based on misgendering and lack of gender affirmation by others might also contribute. The purpose of this study is to examine whether mismatch between gender expression self-perception and perceptions of others is associated with mental health outcomes for cisgender and transgender adolescents. This study combined data from a cross-sectional chart review of 15 randomly selected transgender and 30 age-matched cisgender (1 male, 1 female) adolescent patients receiving care at an Adolescent Medicine Clinic at the University of Utah from 2015 through 2018 who also filled out an in-clinic survey. The survey included information about sex at birth, current gender identity, their own and others’ perceptions of their gender expression. Patients aged 10 to 19 years were included in the study. Survey results were combined with electronic medical record (EMR) mental health profile (presence of symptoms of depression, anxiety, suicidal ideation, and self-harm). We performed t-tests and calculated 95% confidence intervals around means. Statistical significance was set at p-value ≤ .05. Of the 42 patients included in this study (3 were missing survey data), 12 (28.6%) were transgender, 30 (71.4%) were cisgender. We found higher rates (p=0.03, 1-tailed test) of anxiety in transgender patients compared to cisgender adolescents. We found no difference with respect to depression, suicidality, self-harm behavior, or substance use. Patients in this study reported relatively low rates of mismatch between their gender expression assessment and how others see them. We found no differences in rates of gender-perception mismatch between cisgender (mean=0.23, 95% CI: 0.07-0.39) and transgender youth (mean=0.42, 95%CI: 0.09-0.74). We also found no association between mental health outcomes or substance use and gender perception mismatch. Among patients seeking care in the same clinic, we found only limited evidence that transgender patients have significantly worse mental health outcomes compared to cisgender patients. We also found that the transgender patient population in this study does not report higher rates of mismatch between gender self-perception and perception by others. Transgender patients who receive gender-affirming care early in life might be less at risk for negative mental health outcomes compared to the overall trans* population. Our results also suggest that young patients report that others’ perception of their gender is consistent with their self-perceptions of gender. Additional research needs to examine the potential protective effects of this congruency.