Gender Diverse Young People Research Articles

Demographic predictors of experiences of homelessness among lesbian, gay, bisexual, trans, gender-diverse and queer-identifying (LGBTIQ) young people in Australia

ABSTRACT Homelessness among young lesbian, gay, bisexual, trans, gender-diverse and queer-identifying (LGBTQ+) persons is highly prevalent and constitutes a structural risk to health and future life chances. However, the distribution of homelessness burden is among different LGBTQ+ subgroups is poorly understood. An Australia-wide cross-sectional online survey was conducted involving 6,481 LGBTQ+ participants aged 14–21 years during 2019. Single-predictor logistic regression analyses identified factors associated with both lifetime and recent experiences of homelessness. Analyses also explored associations between recent (<12 months) experiences of homelessness, experiences of harassment, alcohol consumption, and psychological distress. Higher odds of experiencing homelessness were observed for trans and gender-diverse young people, individuals who identified with sexual identity labels other than lesbian, gay or bisexual, racially-minoritized persons, disabled persons and individuals from a religious family or household, compared to their respective counterparts. Experiencing homelessness was associated with higher levels of alcohol consumption and higher prevalence of experiencing verbal, physical and sexual harassment, but only modestly associated with higher levels of psychological distress. Homelessness risk and burden is unevenly distributed among LGBTQ+ youth and is linked to outcomes which may potentiate future homelessness. Interventions addressing homelessness among this group must be optimized for those subgroups most vulnerable to experiencing homelessness.

Supporting gender-diverse young people: the role of the nurse.

Gender-diverse individuals will need to access healthcare services for various reasons, with most of this care provided outside of specialist gender services. Nurses have an important role in advocating for the specific needs of gender-diverse individuals and providing person-centred care. Therefore, they have a responsibility to ensure their knowledge of appropriate terminology and gender-affirming interventions is up to date. This article provides information about gender diversity to enhance nurses' understanding of this area to enable them to care for gender-diverse people effectively and sensitively. While the focus of this article is on gender-diverse young people, the same principles can be applied across all age groups.

Affirmation-support, parental conflict, and mental health outcomes of transgender and gender diverse youth

Background: Transgender and gender diverse young people (TGDY) are at higher risk of psychosocial distress relative to their cisgender counterparts. TGDY rely heavily on their parents to support their desired affirmation and to facilitate access to legal and medical affirmation. While it is well understood that parent conflict negatively impacts the well-being of children and young people, little is known about how parental conflict and parental affirmation support are related to TGDY well-being. Aims: The aim of the present study was to (1) explore affirmation experiences of TGDY, as reported by their parents, focusing in particular on parental support for affirmation and barriers to affirmation, and (2) test whether parental support and aspects of the coparenting relationship predicted TGDY mental health outcomes. Method : A sample of 63 parents (Mage = 45.71 years) of TGDY (aged 11 to 17 years) completed an online survey. Results: Almost 90% of the TGDY reported on had socially affirmed their gender, though fewer had taken steps to legally or medically affirm their gender. Parental support for affirmation was generally very high, and reported discrepancies between coparents were generally low; however, discrepancies were greatest for medical affirmation. Finally, parent support for affirmation was a strong predictor of lower TGDY depressive symptoms, though parental conflict did not predict TGDY mental health. Conclusion: Results highlight the important role of parental support for gender affirmation. Further research is needed to track the role of parental support and affirmation on TGDY well-being over time, and to ensure that such research is completed with more diverse samples.

Exploring navigation of gender in a sample of clinically referred young people attending the gender identity development service

BackgroundGender-diverse young people experience a cisnormative world and are subject to unique minority stressors, which have been found to contribute to adverse mental health. This research aims to understand the social and personal context unique to gender-diverse people that young people navigate prior to attending specialised services.MethodsThe baseline measure of a newly developed questionnaire, the GIDS Gender Questionnaire (GIDS-GQ), was sent to all young people (or caregivers for those aged under 12) attending the Gender Identity Development Service (GIDS). Eighty-four young people and caregivers completed the questionnaire, with eighty-one included in the final sample (M = 15.77 years, SD = 1.83, range = 9–17; assigned female at birth = 72, assigned male at birth = 9). Questionnaires were emailed to participants via an online survey between one and three appointments with the Service. Data were collected between April 2021 and February 2022.ResultsAll young people had initiated a social transition, with 75.3% categorised as fully socially transitioned. More young people reported experiencing transphobic bullying (64.2%) and a lack of acceptance of their gender identity (85.1%) in the past (lifetime) than in the 6 months prior to attending the service (transphobic bullying: 12.3%; non-acceptance: 49.4%). 94.5% of the sample reported disliked body parts, most commonly breasts (80.8%), genitals (37%), and hips (31.5%). Participants most commonly reported a decrease in their mood (61.25%) and most areas of social connectedness.ConclusionsThe majority of this sample had socially transitioned, were supported in their identification, and had experienced less transphobic bullying and non-acceptance prior to commencing services. However, young people continued to dislike their bodies, and experience low mood and social connectedness. Future research is needed to understand how clinical support can help reduce the impact of these external/distal minority stressors by promoting social connectedness, incorporating such learnings into clinical practice and subsequent policy in clinical work with gender-diverse young people.

Impact of Hormone Treatment on Psychosocial Functioning in Gender-Diverse Young People.

Purpose: Few studies have assessed the effects of hormonal treatments such as gonadotropin-releasing hormone agonists (GnRHa) and gender-affirming hormones (GAH) on mental health outcomes in clinically referred gender-diverse young people from a younger age. Where this research has been conducted, findings have been mixed. This study investigated a cohort of young people before treatment, 1 year into GnRHa, and 1 year into GAH treatment to understand psychological and behavioral impacts over time. Methods: Thirty-eight young people (28 assigned female and 10 assigned male) referred to endocrinology, younger than 15 years at/beyond Tanner stage two, who received GnRHa followed by GAH treatment, were assessed in a retrospective analysis study. Young people completed the Youth Self Report (YSR), the Body Image Scale, and the Utrecht Gender Dysphoria Scale, while caregivers completed the Child Behavior Checklist (CBCL) and the Social Responsiveness Scale-2 at all time points. Results: Dissatisfaction with primary sexual characteristics (p = 0.02), gender dysphoria (p = 0.01), and social motivation (p = 0.04) improved significantly over time. Self-harm and suicidality also showed a general decrease. Caregivers reported a significant reduction in internalizing (p = 0.03) behaviors on the CBCL after GnRHa. Other subcategories of the YSR and CBCL were within normal ranges with no significant difference (p > 0.05). Conclusion: These findings demonstrate some improvements in psychological and behavioral outcomes in young people concurrently receiving psychosocial support and hormone treatment. Future research with larger and more diverse samples is warranted to further understand generalizability.

“People are having lots of other kinds of sex”: Exploring sexual lifeworlds of LGBTQ+ young people in Bangladesh

A lack of recognition of sexual diversity in Bangladesh continues to contribute to a scarcity in in-depth research around lived experiences of sexual and gender diverse young people. In this article, we adapt a phenomenological reflective lifeworld approach to capture the essential aspects of sexual intimacy as described by diverse young people. This article is based on qualitative data collected in Dhaka, Bangladesh over nine months in 2019 as part of the first author’s doctoral research. Using thematic analysis, we draw on experiences of normative sexual expectations from biographical in-depth interviews with 14 self-identifying lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) individuals aged 18 to 24 years. According to participants, sexual intimacy as experienced by LGBTQ+ young people in Bangladesh meant desiring consensual sexual and romantic relationships with sexually “matched” partner(s) while navigating heteropatriarchal sexuality norms. We observed five interlinked themes which encompassed the sexual lifeworld of young people in our study: desire for romantic intimacy in sexual interactions; need for discretion when navigating sex and relationships; “matching” sexual roles in partnerships; challenges to relational power dynamics of masculinity; and embodying notions of sexual morality. Our findings captured the essence of young people’s sexual lifeworlds in our study and indicate a universality around sexual intimacy while still making space for intersections of diverse lived experiences and social orientations. Further research is required to better understand these nuances in sexual behaviour.

‘Bending’ against straightening devices: queer lived experiences of sexuality and sexual health in Bangladesh

BackgroundDespite global data around increased health risks among sexual and gender diverse populations, lived experiences of young lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+) people are often ignored in mainstream health research. This is particularly evident in countries such as Bangladesh where the rights of sexual minorities are not recognised. This article looks at queer lived experiences of sexuality and sexual health within such a context. We use the phenomenological framework of heteronormative ‘straightening devices’ – mechanisms working to direct people towards heterosexuality, gender conformity, and procreative marriage – to identify ‘invisible’ structures upholding normative sexual behaviours and see how young people in Bangladesh navigate these in their everyday lives.MethodsThis article is based on qualitative data collected in Dhaka, Bangladesh over nine months in 2019 as part of the first author’s doctoral research. Using thematic analysis, we draw on experiences of normative sexual expectations from biographical in-depth interviews with 14 purposively sampled LGBTQ + individuals aged 18 to 24.ResultsRespondents identified heteronormative expectations around gender norms of traditional behaviour and presentation for men and women as well as parental expectations of compulsory heterosexuality through marriage. These straightening devices existed at multiple levels, including individual, interpersonal, community, and societal. The four main themes around straightening devices include marriage norms for women; harassment of feminine-presenting bodies in public spaces; heteronormative healthcare; and consequences of not embodying heteronormativity.ConclusionOur study highlighted young people’s everyday experiences of having to ‘bend’ to – and against – heteronormative straightening devices at home, in public spaces, and within institutions such as healthcare in Bangladesh. The exploration of queer experiences provides new insights into context-specific ways in which sexual and gender diverse people understand themselves. Further research using the framework of straightening devices can help public health professionals to identify more ‘barriers’ confronted by sexual and gender diverse young people.

Trajectories of transgender adolescents referred for endocrine intervention in England

ObjectivesSome gender-diverse young people (YP) who experience clinically significant gender-related distress choose to pursue endocrine treatment alongside psychotherapeutic support to suppress pubertal development using gonadotropin-releasing hormone analogues (GnRHa), and then...

How do gender-diverse young people experience high school? A systematic literature review

AimsThe current review provides an overview of the international research relating to the lived high school (ages 11–16) experiences of gender-diverse young people.MethodWeb and database searches were conducted between October 2019 and January 2020 to identify 12 studies which included direct, first-hand testimonial experiences relating to high school. Data were analysed using thematic synthesis.FindingsThe findings indicate that gender-diverse youth experience a range of both negative and affirming experiences throughout high school linked to key themes including cisnormativity, language, identity, relationships and transphobia.LimitationsNot all database searches proved productive, therefore hand searches, reference harvesting and grey literature searches were also conducted. However, given the variability in terminology within this field, there is the possibility that not all relevant literature may have been captured through this process.ConclusionsFindings are discussed in relation to inclusive practices which schools may adopt to support their gender-diverse students. Strategies include: the avoidance of accommodating approaches to inclusion; adopting rights respecting principles; embedding safe and supportive spaces for self-determination; and providing further training for educators. The paper also discusses implications for professional practice.

Supporting young people to manage gender-related distress using third-wave cognitive behavioural theory, ideas and practice.

The Gender Identity Development Service (GIDS) supports gender diverse young people, and their families but currently does not provide weekly psychological therapy as part of its core work. In addition, local Child and Adolescent Mental Health Services (CAMHS), may feel deskilled in providing support for this population. We, a group of three Clinical Psychologists, aim to share some common themes and observations gained from our work in GIDS. We talk about how existing Cognitive Behavioural Therapy (CBT) models can be relevant and helpful for the challenges facing gender diverse young people, without pathologising, or aiming to change a young person's gender identity. An illustrative case study is presented, based on an amalgamation of young people we have worked with highlighting how third-wave cognitive behavioural theory, ideas and practice can be used to support young people to manage gender-related distress. Further reflections on the broader socio-political context, and implications for clinical practice and future research are discussed.

Beyond inclusion: trans and gender diverse young people’s experiences of PE and school sport

ABSTRACT There is a dearth of research with LGBTQI+ youth in PE and school sport, with particularly deep silences in relation to trans youth. Drawing from a qualitative study with trans and gender diverse youth in second-level schools in Ireland, this paper explores how trans and gender diverse young people are negotiating PE and school sport. A total of nineteen trans and gender diverse young people participated in this study; thirteen young people participated in semi-structured interviews while twelve young people took part in three arts-based workshops. In this paper, we home in on the modalities of inclusion experienced by trans and gender diverse young people as they navigated gendered classification and ordering practices in PE and school sport. Leaning on theoretical insights into the politics of inclusion for LGBTQI+ people, we demonstrate the limited effects of supporting trans and gender diverse young people via individualising methods of inclusion when PE and school-based sport are predicated so fundamentally on an intensely policed cis-heteronormative gender binary. Ultimately, the accounts of the young people in this study steer us towards the necessity to move beyond individualist modalities of inclusion and reimagine the architecture of gender at work in PE and school sport.

Understanding access to healthcare for gender diverse young people: a critical review of the literature

Gender diverse young people face well-documented physical, mental and sexual health disparities compared to the general population. Differential access to healthcare is a key driver of these inequities and literature highlights high unmet healthcare need among members of this group. Healthcare access has been described through a model that defines five dimensions of health services: approachability; acceptability; availability and accommodation; affordability; and appropriateness; and five abilities of health service consumers that interact with these dimensions: the abilities to perceive, seek, reach, pay and engage. This comprehensive literature review examined barriers to and facilitators of healthcare access among gender diverse young people using the lens provided by this model as it relates to dimensions of access at the health service level and/or the abilities of health service users. We advocate expansion of this model to incorporate demand- and supply-side barriers and facilitators of access, and important structural factors including the gender binary health system framework, intersectionality and stigma. Findings highlight the need for improvements to healthcare provider education and the participatory redesign of health services with a focus on intersectionality, individually-tailored service provision and healthcare that is responsive to the unique needs of gender diverse young people.

Artistic expression as a source of resilience for transgender and gender diverse young people

There is a paucity of research exploring sources of resilience among transgender and gender diverse (TGD) young people with multiple marginalized identities. Information and communication technologies (ICTs) offer unique opportunities for authentic self-expression, which is not always possible offline. The primary aims of this study were to understand unique sources of resilience among TGD youth in their online and offline lives. Using photo elicitation and grounded theory methods, we conducted online in-depth interviews with TGD young people (N = 29) between the ages of 14–25 across the United States identifying with at least one of the following social statuses: (a) person of color, (b) immigrant, or (c) living in a rural area. Four themes were identified from the data, with both online and offline artistic expression being viewed as a: (1) form of authentic self-expression; (2) coping mechanism; (3) way to connect to others; and (4) pathway toward agency. Findings advance understanding about the use of artistic expression as an underexamined source of resilience among TGD youth with multiple marginalized identities. Within clinical settings, options for TGD youth to participate in various forms of expressive art may improve engagement and enhance youths’ abilities to authentically express their thoughts, feelings, and experiences to promote healing and growth.

Shifts in demographics and mental health co-morbidities among gender dysphoric youth referred to a specialist gender dysphoria service.

Past research has identified shifts in the demographics and co-occurring mental health issues of youth referred to certain gender dysphoria services. The present study examined shifts in demographics (age, sex and social transition status), social adversity (bullying experiences and abuse) and psychological functioning (mood, anxiety, suicidality and autism spectrum disorder) at time of referral (of both children and adolescents) to the Gender Identity Development Service, London between the years of 2012 and 2015. Patients were 782 children and adolescents (M = 13.94, SD = 2.94, range 4-17; 63.8% assigned female at birth). Little change in sex ratio or age was observed between these two time points. However, we observed greater rates of depression and anxiety of birth-assigned females (but not birth-assigned males) in the more recent cohort, at the same time that reported social adversity (bullying and abuse) was falling. Also, of interest, the proportion of young people who had partially or fully socially transitioned prior to contact with the service had increased overtime. We discuss potential factors driving these shifts and their implications for supporting recent cohorts of gender diverse young people.

Identifying trans and non-binary youth in population-based school health surveys in western Canada

Abstract Background Most research about gender-diverse adolescents is with clinical samples, skewing population estimates of health and risk. With trans youth estimated at around 0.5% of the population and no reliable measures, school health surveys have not asked gender diversity items. In 2018, the British Columbia Adolescent Health Survey (BCAHS) in Canada trialled measures to differentiate cisgender, trans, and non-binary youth, to capture a representative picture of health for gender-diverse young people. Methods The 2018 BCAHS is a stratified random survey of 2,175 classrooms of grades 7-12 (ages 12-19) in 58/60 school districts province-wide (N = 38,015). Two measures asked about sex assigned at birth and current gender identity, combined to identify cisgender boys and girls, trans boys, trans girls, non-binary and questioning youth. We examined patterns of missingness by demographics. Results Overall, nearly 99% of youth responded to both items, with very low missing (0.5% for sex, 0.8% gender identity) with no differences by school or district, or by age. Missing responses were higher among international students and English language learners but still low (1.1%). Youth living in foster care or with a disability or chronic condition also had higher odds of skipping both items, but the highest missing was only 3.7% among youth with FASD. Overall, 48.9% identified as cis girls, 48.6% as cis boys, 0.13% as trans girls, 0.33% trans boys, 0.75% non-binary, and 1.28% as not sure (479 trans/non-binary, and 484 unsure). Preliminary analyses show positive assets also support gender diverse youth well-being. Conclusions A two-step measure of gender identity is feasible for adolescents as young as 12 years old in large scale school surveys, with very low missing responses in western Canada. Although &amp;lt;1% identified as trans, in large samples stable estimates for population comparisons are possible. Future studies should pilot gender identity measures in other nations/languages.

Queer homelessness: the distinct experiences of sexuality and trans-gender diverse youth

Queer young people, or young people who are sexuality diverse and/or trans and gender diverse, face a higher lifetime likelihood of homelessness than their cis-heterosexual peers. However, queer young people are often treated as a homogenous group within research, a methodological decision that obscures differences on the basis of gender identity. Drawing upon 2,159 intake records from a youth housing program in Australia, the authors compare the experiences of (i) cis-heterosexual; (ii) sexuality diverse; and (iii) trans and gender diverse young people across a number of domains related to vulnerability, including victimization and violence, health, substance use, and support systems. Eighteen percent of young people in the sample identified as queer, and five percent identified as trans or gender diverse. Queer young people were more likely to report family and intimate partner violence, poor mental health, and recent substance use than cis-hetero youth. Trans and gender non-conforming respondents were more likely than sexuality diverse peers to be experiencing current, rather than past, family violence, and less likely to report intimate partner violence and substance use. We conclude by discussing these issues within the context of past research and their implication for future research and practice within the homelessness sector.

Gender minority stress in trans and gender diverse adolescents and young people.

Gender minority stress refers to social stressors such as discrimination and stigma that gender minorities are subject to. This study examines the relationship between gender minority stress and psychological well-being in trans and gender diverse young people (TGDYP). We used a cross-sectional design to investigate the relationship between gender minority stress and mental well-being in TGDYP aged 16-25. We measured anxiety, depression, general psychological well-being, gender dysphoria, gender minority stress (distal and proximal), resilience and heteronormative beliefs in cisgender (n = 135) and trans and gender diverse (TGD) (n = 106) participants. Hierarchical regression was used to analyse the data. TGD participants had significantly higher levels of anxiety and depression, and poorer general well-being, than cisgender participants. Although the direction of the relationship cannot be determined through our analysis, TGD participants who experienced more minority stress and were assigned female at birth had higher levels of depression and anxiety. TGD participants with higher resilience scores and were assigned male at birth had better well-being overall. Our findings suggest that we should pay attention to minority stress when thinking about how to reduce anxiety and depression in TGDYP. The responsibility for improving well-being lies not just with services but instead should be held by our whole society.

Between social and biomedical explanation: queer and gender diverse young people’s explanations of psychological distress

ABSTRACT The psychological wellbeing of Queer and Gender Diverse Young People (QGDYP) has received attention of late, and increasing research evidences much higher rates of psychological distress experienced by these groups, compared to their straight, cisgender counterparts. Far more limited is research exploring queer and gender diverse young people’s own perspectives on their psychological wellbeing, an absence we address with the current study. We interviewed 21 queer or gender diverse 16–18-year-olds in Aotearoa New Zealand about their understandings of mental health and wellbeing. We took a critical realist thematic approach to analysis. This paper focuses on how participants made sense of their own distress. We explore and unpack three intersecting key themes around: 1) cisheterosexism, but not personally affected; 2) dismissal of QGDYP; and 3) validation and comfort in the biomedical model. We discuss the tensions of articulating these positions and (also) challenging cisheterosexism, and the implications for recognising and reducing the distress experienced by queer and gender diverse youth. We aim to inform policy and practice to support and ultimately improve psychological wellbeing for queer and gender diverse young people.

Differential Experiences of Mental Health among Transgender and Gender-Diverse Youth in Colorado.

Young people experience a variety of mental health concerns, including depression, non-suicidal self-injury, and suicidal ideation. These issues are at even higher rates among transgender and gender-diverse (TGD) young people, due to the additional burden of having to navigate a world in which transphobia impacts them at the individual, organizational, and policy levels. However, much of the extant research focuses only on comparing TGD youth to cisgender counterparts. This study explores the nuance within the TDG youth population regarding mental health, examining how gender, race/ethnicity, and sexual orientation change the likelihood of experiencing each of these mental health concerns. Among a sample of over 400 young people, findings indicate that those TGD young people who do not identify themselves within the masculine/feminine binary and those with marginalized sexual orientations were two to three times more likely to experience adverse mental health outcomes, as compared to their peers who are questioning their gender, and who are heterosexual. The implications for mental health professionals and others who work with young people are to recognize that mental health is not a one-size-fits all model for young TGD people, and that the intersection of multiple marginalized identities, must be addressed in order to improve the mental health of this group of young people. Findings can also be used to better understand issues of stigma, discrimination, and victimization in education, health care, and beyond.

‘Game to play?’: barriers and facilitators to sexuality and gender diverse young people's participation in sport and physical activity

ABSTRACT Sport settings have long been documented as exclusionary environments for sexuality and gender diverse (SAGD) people and a key location of discrimination. Sport is associated with well-being, and increasing physical activity for disadvantaged groups is a key aim for many governments. This study reports on 13 semi-structured interviews with young SAGD people aged 18–24 in Australia that explore their attitudes to and experiences of sport and physical activity. We found that SAGD young people are ‘game to play’: they hold strong desires to participate in sport and physical activity, and articulated how sport could be more inclusive. Using Bourdieu's concept of ‘capital’, we outline how young SAGD people identify sport as a ‘field’ that requires and fosters various types of capital. We explore barriers they identified that prevent the accumulation of physical and social capital associated with sport participation and physical activity, and their insights for how this may be fostered. The ‘field’ of sport presents as an exclusionary environment, which allows for both explicit bullying and more subtle discriminatory practices. Passive assimilation approaches are not enough to provoke substantial change and active intervention is required to decentre the heteronormativity underpinning these spaces, which has implications for policy and practice to advance the inclusion of SAGD young people in sporting environments.