Gender Expansive Youth Research Articles

MHealth for transgender and gender-expansive youth: harnessing gender-affirmative cross-disciplinary innovations to advance HIV prevention and care interventions.

Transgender and gender-expansive (TGE) youth endure stark disparities in health and wellbeing compared to their cisgender peers. A key social determinant of health for TGE adolescents and emerging adults is gender affirmation, which encompasses multidimensional validations of an individual's lived gender. Lacking available resources for one's gender affirmation, TGE young people may engage in high-risk maladaptive coping behaviors, linked to their disproportionately high HIV-acquisition risk. A range of innovative mobile technologies are guided by the Gender-Affirmative Framework to promote the health of TGE communities, including through HIV prevention and care continuum outcomes. The aim of this review was to examine key features of existing mobile technologies that can be leveraged to advance the field of TGE-responsive mHealth. We systematically searched scientific records, gray literature, and the iOS and Android app distribution services. To be eligible, platforms and interventions needed to be tailored exclusively to a TGE user base, incorporate gender-affirming features, and be optimized for or adaptive to mobile technologies. Eligible interventions (N=24) were compared on evidence of utility, core functionalities, and dimensions of gender affirmation. Smartphone applications (apps) and webapps (n=16) were the most common delivery modality. Many interventions (n=9) aimed to address HIV-related outcomes and integrated gender-affirmative features. The most common gender-affirmative features originated in fields of human-computer interactions and informatics, or were crowdfunded by TGE developers. HIV-focused interventions incorporated evidence-based health behavior change strategies and utilized rigorous evaluation methods. Across modalities and disciplines, behavioral self-monitoring and access to HIV prevention services were the most frequent features. Over two-thirds of the interventions reviewed aimed to provide medical gender affirmation (e.g, provided guidance on obtaining medically sanctioned hormone therapies, or safely practicing non-medical options such as chest-binding) or psychological gender affirmation (e.g, provided linkage to mental health counseling). Our results show that mHealth and other technology-mediated interventions offer a diverse range of both evidence-based and innovative features; however, many have not been rigorously evaluated in a randomized controlled trial to support TGE users. A continuing commitment to evidence-based health behavior change strategies, exemplified by the HIV-focused interventions included in this review, is essential to advancing gender-affirmative mHealth. The unique and highly innovative features of platforms originating outside the fields of HIV prevention and care suggest new directions for TGE-responsive mHealth, and the need for more conscientious models of knowledge exchange with investigators across scientific disciplines, private-sector developers, and potential users.

Critical participatory action research: Methods and praxis for intersectional knowledge production.

Building on the conceptual foundation of articles published in the 2005 volume of the Journal of Counseling Psychology on the qualitative turn in Counseling Psychology, we write to introduce and reflect on Critical Participatory Action Research (CPAR) as an intersectional approach to knowledge production by psychologists researching alongside individuals, communities, and movements dedicated to social justice. We open with a brief review of the origins of CPAR and the epistemological commitments of this approach to inquiry. We then explore why and how participation matters, and the delicate dynamics of CPAR through various phases of research: putting together a research team, crafting research questions and design, selecting methods, sampling, participatory analyses of qualitative and quantitative material, and figuring out how to produce and circulate findings in ways accountable to the community/movement of interest. The second half of the article offers a slow journey into one CPAR project, What's Your Issue?, a multigenerational, national, participatory survey designed by and for LGBTQIA+ youth, with an emphasis on the participation and representation of youth of color. We write this article for scholars, practitioners, activists, educators, and students to make visible why participation is so crucial to social justice research; that "no research on us, without us" is both scientifically and ethically valid, and how mixed methods research with LGBTQIA+ and gender-expansive youth can open new horizons for theory, methods, and action. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Beyond Bathroom Bills and the Gender Identity Debate: Complicating the Policy Conversation About Supporting Trans Students in Schools

Schools and districts across the country have been thrust into the political limelight as they grapple with sometimes competing policy messages about the education of transgender and gender expansive students. Drawing on 2 years of survey data from families of transgender and gender expansive youth in one mountain state, this article uses critical trans politics to examine the ways the current policy climate aligns with the supports schools provide. Results suggest that parents desire policies and practices that transform cis-heteronormative school structures, and they recognize that policy is often limited in its ability to affect the material experiences of youth in schools. We therefore argue that a focus on bathroom bills and policies regarding trans accessibility have distracted from a conversation that needs to be elevated to address broader structural issues and should ultimately be driven by families and trans youth.

Affirming Pediatric Care for Transgender and Gender Expansive Youth.

Transgender and gender diverse children and youth experience significant health disparities and adverse health outcomes. Pediatricians have an opportunity to improve those outcomes by practicing gender-affirming care. This includes creating a welcoming environment through changes in office settings, intake forms, communication skills, language used, and support for families. Clinicians should be comfortable discussing social transition, puberty blockers, and gender-affirming hormone therapy with patients as needed. For clinicians caring for teenagers, adaptations in sexual health counseling and fertility counseling are necessary. Clinicians should also be aware of the trauma that has been historically inflicted by the medical and mental health system against people who identify as transgender/nonbinary, and that significant disparities exist even within this group along racial and gender lines. These aspects of caring for gender diverse youth are part of primary care pediatrics, and further education in these areas will improve access to care and health outcomes for these youth. [Pediatr Ann. 2021;50(2):e65-e71.].

Prevalence and Risk Factors for Nonsuicidal Self-Injury in Transgender and Gender-Expansive Youth at a Rural Gender Wellness Clinic.

Purpose: Transgender and gender-expansive (TGE) populations are at increased risk for nonsuicidal self-injury (NSSI). Rural TGE populations are understudied and underserved in terms of mental health services. The purpose of this study was to determine lifetime prevalence of NSSI among TGE youth at a rural gender wellness clinic and identify demographic and clinical characteristics associated with NSSI. Methods: The Gender Wellness Center Pediatric Patient Registry, a comprehensive database of 185 TGE youth ≤25 years of age, provided an estimate of the lifetime prevalence of NSSI. Univariate logistic regression models were utilized to test associations between patient demographic and clinical characteristics and NSSI. Variables that met the threshold for significance in the univariate analyses (p<0.05) were entered into a multivariate logistic regression model. All statistical analyses were conducted in SAS v.9.4. Results: Prevalence of NSSI in the sample was 36.8% (n=68). In unadjusted logistic regression models, risk factors for NSSI included female assigned sex at birth, transmasculine spectrum gender identity, history of mood disorder, history of suicidal ideation (SI) or attempt, and history of abuse (p<0.05). In the adjusted model, variables significantly associated with NSSI included female assigned sex at birth, history of mood disorder, and history of SI or attempt. Conclusion: NSSI was highly prevalent in this sample of rural TGE youth, confirming the need for screening and early interventions that target the unique vulnerabilities of TGE youth. The complex interplay of sex assigned at birth, mood disorders, and NSSI requires further research.

Learning to endure: A qualitative examination of the protective factors of homeless transgender and gender expansive youth engaged in survival sex

Background: Transgender and gender expansive (TGE) youth face a number of adversities that are associated with deleterious consequences, including mental health problems, substance misuse, suicide, and homelessness. However, there is evidence that TGE youth still demonstrate resilience under extraordinary conditions. Aims: Therefore, this study examined how TGE youth who are homeless and engaging in survival sex describe and understand the protective factors present in their lives. Methods: In-depth qualitative interviews were conducted with 57 TGE youth living in a large U.S. city. Participants were 17-26 years old (M = 19.88, SD = 1.55), and identified as transgender woman (53%), transgender man (16%), and other (32%; gender-queer, gender-fluid, androgynous, or non-binary). Youth identified as Black (40%), multiracial (35%), Latinx (16%), White (5%), and as another race (3%). Researchers conducted a secondary analysis of qualitative data using thematic analysis. Results: We identified three themes to capture youth’s understanding of their protective factors: relying on oneself and others to avoid violence, accessing gender-affirming health and mental health care, and proactively maintaining sexual health. Participants described strategies for mitigating risk of harm while attempting to meet their basic needs. Additionally, they discussed the importance of having gender-affirming health and mental health services. Participants also expressed keen awareness of their sexual health risks and making calculated, often proactive decisions about their sexual health. Conclusion: The protective factors described by TGE youth reflect the unique ways in which hyper-marginalized youth must navigate their own survival and well-being, and align with literature suggesting resilience is not mutually exclusive from risk. By focusing on TGE youth, this research privileges the experiences of individuals historically underrepresented in research and encourages future research to incorporate these perspectives into policies and programs.

Parents matter: Considering evidence-based relationship variables within families when working with gender expansive youth.

Parents matter: Considering evidence-based relationship variables within families when working with gender expansive youth.

Transgender and gender‐expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families

Society's blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifically nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary. To clarify the areas of potential impact in the nurse's role and to discuss ways in which they can better equip themselves to promote effective communication and culturally competent care. Thus, we envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self-harm, and suicidal ideation in our transgender and gender-expansive youth. Utilizing PubMed, nationally recognized websites, and current textbooks/pamphlets, a literature review was conducted to ascertain pertinent information related to transgender, gender-expansive youth, and nursing education. Included references were from 2012 to the present. Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources.

Improving clinical encounters for transgender and gender expansive youth at Children’s Hospital Colorado

Improving clinical encounters for transgender and gender expansive youth at Children’s Hospital Colorado

Advocating for Transgender and Gender Expansive Youth in the Emergency Setting

Transgender and gender-expansive (TGE) youth represent a diverse population with unique health needs. Inadequate education and training in gender-related health hamper pediatric emergency medical providers' ability to offer affirming care to TGE youth. Increasing staff education and competency and advocating for welcoming spaces and inclusive practices are ways that emergency medical care providers can offer culturally affirming clinical care to patients and families. Additionally, emergency medical providers can play key roles in advocating for improved health care for TGE youth both within and outside of their health organization.

A Pilot Study to Assess Attitudes Toward Future Fertility and Parenthood in Transgender and Gender Expansive Adolescents

Purpose: In this pilot study, we sought to characterize the knowledge about fertility and attitudes about future parenthood in a sample of transgender and gender expansive (TGE) youth attending an ...

The experiences of transgender and gender expansive youth in Juvenile justice systems

PurposeRecent research finds that youth who identify as transgender or gender-expansive are disproportionately incarcerated in juvenile justice systems and are treated differently from their non-trans peers (Himmelstein and Brückner, 2011; Hunt and Moodie-Mills, 2012; Irvine, 2010; Mitchum and Moodie-Mills, 2014). Juvenile justice systems have paid little attention to this group of young people in terms of their unique service needs and risk factors. Using qualitative methods, the researchers analyze in-depth interviews and focus group findings from formerly incarcerated trans youth in juvenile justice settings to better understand their experiences. This paper aims to examine the challenges for young people, and, as well as considered recommendations for juvenile justice professionals to study toward making changes in policies, practices and programs that are needed to support young people who are transgender or gender expansive.Design/methodology/approachUsing qualitative, case examples and descriptive analysis, this paper describes the experiences of trans youth in juvenile justice settings and studies toward developing models of promoting trans-affirming approaches to enhance juvenile justice institutions for trans and gender-expansive youth placed in them. The paper describes the evolution of an approach used by the authors, in New York state juvenile justice settings to increase a trans-affirming perspective as a central role in the organization’s strategy and design, and the methods it is using to institutionalize this critical change. Findings culled from the focus groups and in-depth interviews with 15 former residents of juvenile justice settings and several (3) key staff members from the juvenile justice system, focusing on policies, practices and training models are useful tools for assessing progress and recommending actions to increase the affirming nature of such systems. At its conclusion, this chapter will provide clear outcomes and implications for the development of policies, practices and programs with trans and gender expansive youth in juvenile justice systems.FindingsFinding are conceptualized in six thematic categories, namely, privacy, access to health and mental health care, the difference between sexual orientation and gender identity, name and pronoun use, clothing, appearance and mannerism, and housing issues.Research limitations/implicationsThis study is limited as it focuses on formerly incarcerated youth in the New York City area.Practical implicationsThe following implications for practice stemming from this study are as follows: juvenile justice professionals (including judges, defense attorneys, prosecutors, probation officers and detention staff) must treat – and ensure others treat – all trans and gender-expansive youth with fairness, dignity and respect, including prohibiting any attempts to ridicule or change a youth’s gender identity or expression. Having written nondiscrimination and anti-harassment policy is also essential. These policies can address issues such as prohibiting harassment of youth or staff who are trans or gender expansive, requiring the use of respectful and inclusive language and determining how gender rules (e.g. usage of “male or “female” bathrooms, gender-based room assignments) will be addressed for transgender and gender-nonconforming youth. Programs should also provide clients and staff with training and helpful written materials. Juvenile justice professionals must promote the well-being of transgender youth by allowing them to express their gender identity through choice of clothing, name, hair-style and other means of expression and by ensuring that they have access to appropriate medical care if necessary. Juvenile justice professionals must receive training and resources regarding the unique societal, familial and developmental challenges confronting trans youth and the relevance of these issues to court proceedings. Training must be designed to address the specific professional responsibilities of the audience (i.e. judges, defense attorneys, prosecutors, probation officers and detention staff). Juvenile justice professionals must develop individualized, developmentally appropriate responses to the behavior of each trans youth, tailored to address the specific circumstances of his or her or their life.Social implicationsProviding trans-affirming services to youth in juvenile justice settings is a matter of equity and should be the goal strived for by all systems that care for these young people. Helping trans and gender-expansive youth reenter and reintegrate into society should be a primary goal. There are many organizations and systems that stand ready to assist juvenile justice systems and facilities in supporting trans and gender expansive youth in their custody and helping them to rehabilitate, heal and reenter a society that welcomes their participation and where they can thrive and not just survive.Originality/valueThe paper is original in that it examines the lived experiences of trans and gender-expansive youth in juvenile justice systems. An area, which has not been fully explored in the professional literature.

Gender expansive youth disclosure and mental health: Clinical implications of gender identity disclosure.

Some healthcare providers work with gender expansive youth, and preliminary evidence notes that many of these youth do not disclose their gender identity to all of their healthcare providers. No previous research focused on youth has explored gender identity disclosure to healthcare providers, nor linked youth disclosure to negative mental health outcomes (e.g., symptoms of depression). Data were drawn from the LGBTQ National Teen Survey in order to test the relationship between gender identity disclosure, symptoms of depression, and self-esteem among 5,637 13- to 17-year old (M age = 15.6) participants who identified as transgender boys, transgender girls, non-binary youth who were assigned female at birth (AFAB), or assigned male non-binary youth who were assigned male at birth (AMAB). Transgender boys reported the highest symptoms of depression and the lowest levels of self-esteem in comparison to other groups. Among the full sample, 66.8% had not disclosed their gender identity healthcare providers-non-binary AMAB youth were least likely to disclose (77.6%). Symptoms of depression were the highest and self-esteem was the lowest for transgender boys with mixed levels of disclosure. Transgender girls reported the lowest symptoms of depression - these youth had also disclosed their identities the most. Findings suggest that mixed disclosure to healthcare providers is problematic for gender expansive youth, especially transgender boys. Findings suggest a need to better prepare health professionals to understand not all gender expansive youth may feel comfortable disclosing their gender identities in medical contexts. Future research should explore gender affirmative healthcare as a potential protective factor in combatting negative mental health outcomes.

Health-related quality of life among transgender and gender expansive youth at a rural gender wellness clinic.

To address a critical gap in the existing Health-Related Quality of Life (HRQOL) literature by quantifying and describing HRQOL among transgender and gender expansive (TG/GE) youth at a rural gender clinic and comparing the HRQOL of these youth to age-stratified United States (U.S.) population standards. This cross-sectional study includes results of the baseline HRQOL assessment of 141 TG/GE patients enrolled in the Gender Wellness Center (GWC) Pediatric Patient Registry. HRQOL was assessed using the Child Health Questionnaire-Child Form 87 (CHQ-CF87; ages < 18) and the Short Form-36 (SF-36v2; ages 18-21). Mean subscale scores were compared to the most current U.S. population standards available. On all but one of the CHQ-CF87 subscales, TG/GE youth scored significantly lower than 2015-2016 U.S. general population youth and youth with two chronic conditions. On the SF-36v2, TG/GE youth scored significantly higher than 2009 U.S. standards on all physical health domains but lower on all but one of the mental health domains. Cross-sectional HRQOL data from a registry of TG/GE youth indicate significantly poorer mental health measures as compared with the U.S. general population. Longitudinal assessments are needed to evaluate whether HRQOL improves with gender-affirming care. Future studies should aim to identify sociocultural factors at the intersection of rurality and health that contribute to diminished HRQOL among rural TG/GE youth.

Advocacy-in-Action: Case Portrait of a Helping Professional Pursuing Positive Social Change for Transgender and Gender-Expansive Youth

Transgender and gender-expansive youth experience discrimination and marginalization in the healthcare setting, school environment, their communities, and families. These experiences of rejection and adversity are correlated with higher rates of suicidality, depression, and other mental health concerns. Helping professionals play an essential role in mitigating experiences of oppression by advocating for positive social change for their transgender and gender-expansive clientele. Through the provision of a single case portrait, this article explores the advocacy-in-action of Craig, a helping professional and advocate, as he pursues positive social change for transgender and gender-expansive youth. Merriam’s (1988) interpretive case study was used to guide data collection and findings. Emergent themes provided concrete examples of how the American Counseling Association (ACA) endorsed an advocacy model, and the Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling Competencies for Counseling Transgender Clients apply to this population. Including the concepts of intrapersonal and interpersonal advocacy to the current advocacy model is critical to advancing the health of transgender and gender-expansive youth. Implications for counselors and counselors in training will also be discussed.

The intersectionality of identity-based victimization in Adolescence:A person-centered examination of mental health and academic achievement in a U.S. high school

IntroductionGrowing evidence indicates that identity-based victimization (IBV; e.g., discrimination) is traumatic, and associated with mental health and academic concerns. Youth with multiple stigmatized identities face a higher risk of both victimization and poor mental health. The current study enhances a growing research base on intersectional IBV by examining 1) identity, rather than attribution, 2) a range of IBV experiences, 3) both mental health and academic achievement, 4) the mediating role of discrimination across multiple social identities, and 5) including gender expansive youth within a diverse sample representative of a high school population in the U.S. MethodsA cluster analysis was conducted to provide a nuanced depiction of intersectionality in a diverse sample of high school students (N = 946; ages 14–20, 44% cisgender boys, 53% cisgender girls, 3% gender expansive youth). Outcome and IBV differences across clusters were examined, in addition to the mediation of cluster membership and outcomes by discrimination. ResultsThree distinct profiles of identity emerged: LGBTQ Youth (24%), Heterosexual Youth of Color (37%), and Heterosexual White Youth (39%). LGBTQ Youth and Heterosexual Youth of Color experienced the most IBV, and had higher levels of depression, lower wellbeing, and lower GPAs. Finally, discrimination partially mediated the association between identity and outcomes for LGBTQ youth, and fully mediated this association for Heterosexual Youth of Color. ConclusionsThe disproportionately of IBV, poor mental health, and lower academic achievement faced by LGBTQ youth and youth with intersecting stigmatized identities suggests that they may benefit from tailored and targeted treatments.

Sexual and reproductive health considerations among transgender and gender-expansive youth

Sexual and reproductive health are an integral part of all youths' health and wellbeing, including youth who are transgender and gender-expansive. This article will discuss general approaches to the sexual and reproductive health care of transgender and gender-expansive youth, and review the topics of contraception and menstrual suppression, fertility preservation and family building, and the prevention and treatment of sexually transmitted infections and HIV in this population. Although transgender youth on testosterone therapy often become amenorrheic, ovulation and pregnancy can still occur, and thus all youth on testosterone therapy should be counseled on the potential for pregnancy and have access to effective contraception. Many forms of hormonal contraceptives are both safe and efficacious when used by youth on testosterone therapy. Hormonal contraceptives may also be used to provide menstrual suppression for those experiencing dysphoria from unwanted uterine bleeding. All transgender youth should receive counseling on fertility preservation and reproductive options prior to starting pubertal blockers and/or gender-affirming hormones, therapies that have varying effects on long-term fertility potential. Several different methods of fertility preservation exist, however there are numerous barriers to transgender youth receiving fertility preservation services, and rates of utilization of these services is low. Transgender individuals suffer from a disproportionate burden of HIV compared to their peers-thought to result from stigma, marginalization, and lack of access to appropriate care. All providers caring for youth should be informed about HIV pre-exposure prophylaxis (PrEP) and HIV post-exposure prophylaxis (PEP), which may help to prevent HIV acquisition.

Critical Participatory Action Research: A Feminist Project for Validity and Solidarity

We present critical participatory action research as an enactment of feminist research praxis in psychology. We discuss the key elements of critical participatory action research through the story of a single, national participatory project. The project was designed by and for LGBTQIA+ (lesbian, gay, bisexual, trans, queer, intersex, asexual, plus) and gender-expansive youth; it was called What’s Your Issue? We provide details of the research project, the dreams, desires, experiences, and structural precarity of queer and trans youth. We write this article hoping readers will appreciate the complexities of identities, attend to the relentless commitment to recognition and solidarities, learn the ethical and epistemological principles of critical participatory action research as a feminist and intersectional praxis, and appreciate the provocative blend of research and action toward social justice. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

Sexual Assault Risk and School Facility Restrictions in Gender Minority Youth.

In the current issue of Pediatrics , Murchison et al1 have shown that transgender and gender nonbinary adolescents restricted from using school restrooms and locker rooms that match their gender identity had an increased risk of sexual assault. Data were derived from an anonymous online survey of >3000 lesbian, gay, bisexual, transgender, and queer adolescents, with respondents being from throughout the United States. The increased risk of sexual assault was observed in transgender boys, nonbinary adolescents designated female at birth, and transgender girls.1 The findings of this study make a compelling case for what we as gender specialist providers witness every day in our work: failure to support transgender and gender-expansive youth in being able to fully live in their affirmed gender puts them at physical as well as psychological risk.2 Yet, with respect to school restrooms … Address correspondence to Stephen M. Rosenthal, MD, Global Health and Clinical Sciences, University of California, San Francisco, Mission Hall, 550 16th St, Fourth Floor, San Francisco, CA 94143. E-mail: stephen.rosenthal{at}ucsf.edu

Book forum

Transgender and gender expansive youth face increased challenges in many realms, including home, school, foster care, the legal system, and health care. They have a disproportionately elevated risk of developing depression and suicidality, but continue to be pathologized and invalidated by clinicians without adequate knowledge of the relevant issues. This can make it extremely difficult for transgender youth to access safe and gender-affirming mental health services. As members of the child psychiatry community, we must educate ourselves to become competent providers and advocates for this vulnerable, often underserved population.