Transgender Youth Research Articles

Family planning preferences in transgender youth in an urban multi-disciplinary gender clinic

BackgroundKnown barriers to family planning in the transgender population include low utilization of cryopreservation and decisional regret. There is growing data on the risk of infertility with GAHT, and on to what degree transgender adolescents feel informed about fertility and family planning options. ObjectiveAssess preferences regarding options for family planning and fertility preservation in transgender adolescents treated with GAHT in a pediatric endocrinology gender clinic. The goal is to enhance patient education about potential effects of GAHT on fertility and options for family planning. MethodsForty one adolescents aged 10 years and older treated with GAHT in an urban outpatient pediatric endocrinology clinic were surveyed over a 6-month period from January to June 2022. Survey questions were multiple choice, Likert scale, and open-ended. Participants were at least 10 years of age, actively followed in the clinic, and receiving GAHT at time of enrollment. ResultsForty one participants completed the survey. Four (10 %) expressed interest in discussing family planning with their provider. Eighteen (45 %) were open to discussion in the future; 16 (39 %) were not interested at all. 12 (30 %) participants were planning for future parenthood, and 16 (40 %) participants were undecided. Of those interested in parenthood 7 (53.8 %) planned to adopt or foster. Barriers to family planning expressed included financial concerns, potential need to pause GAHT, and social stigma of transgender parenthood. Twenty (50 %) participants recalled prior family planning discussion with their endocrinologist. ConclusionFamily planning discussions may not be optimally impactful given that 50 % of participants did not recall the conversations. Family planning is a lower priority in this population as most desired to postpone discussion with their provider despite choosing treatment that could influence fertility. It is essential to identify methods to engage transgender youth in discussions related to family planning during GAHT.

Children's attitudes about transgender identity disclosure and concealment.

Supportive peers are crucial for transgender children's well-being. Transgender children who live in their affirmed gender face decisions surrounding concealment and disclosure of their transgender identity. We sought to understand how cisgender (N = 115) and gender-diverse children (N = 127), and siblings of gender-diverse children (N = 63) think about transition disclosure and concealment. All groups viewed transition disclosure and concealment positively. However, gender-diverse children showed greater acceptance of transition concealment and had stronger liking of transition concealers (relative to non-transition concealers). Additionally, children generally expected transgender peers to be selective about who they disclose to, valuing trustworthiness and diverse friend groups in such decisions. Our findings suggest that regardless of gender identity, children are sensitive to the potential costs of disclosure and may support trans children however they choose to navigate these decisions.

Estimating Transgender and Gender-Diverse Youth Populations in Health Systems and Survey Data.

To identify and examine demographic variation in estimates of gender-diverse youth (GDY) populations from the PEDSnet learning health system network and the Youth Risk Behavior Survey (YRBS). The PEDSnet sample included 14- to 17-years-old patients who had ≥2 encounters at a member institution before March 2022, with at least 1 encounter in the previous 18 months. The YRBS sample included pooled data from 14- to 17-year-old in-school youth from the 2017, 2019, and 2021 survey years. Adjusted logistic regression models tested for associations between demographic characteristics and gender dysphoria (GD) diagnosis (PEDSnet) or self-reported transgender identity (YRBS). The PEDSnet sample included 392 348 patients and the YRBS sample included 270 177 youth. A total of 3453 (0.9%) patients in PEDSnet had a GD diagnosis and 5262 (1.9%) youth in YRBS self-identified as transgender. In PEDSnet, adjusted logistic regression indicated significantly lower likelihood of GD diagnosis among patients whose electronic medical record-reported sex was male and among patients who identified as Asian, Black/African American, and Hispanic/Latino/a/x/e. In contrast, in the YRBS sample, only youth whose sex was male had a lower likelihood of transgender identity. GDY are underrepresented in health system data, particularly those whose electronic medical record-reported sex is male, and Asian, Black/African American, and Hispanic/Latino/a/x/e youth. Collecting more accurate gender identity information in health systems and surveys may help better understand the health-related needs and experiences of GDY and support the development of targeted interventions to promote more equitable care provision.

Mental health after the COVID-19 pandemic among Finnish youth: a repeated, cross-sectional, population-based study

High levels of mental health problems among young people were reported during the COVID-19 pandemic, but studies of the post-pandemic period are scarce. We assessed mental health problems among Finnish youth before, during, and after the COVID-19 pandemic using nationwide population-based samples. Our aim was to examine in which direction the heightened levels of adolescent mental health problems have developed after the pandemic. In this national, repeated cross-sectional, population-based study in Finland, we recruited students at lower and upper secondary level (aged 13-20 years) who were taking part in the Finnish School Health Promotion (SHP) survey in 2015-23 (119 681-158 897 participants per round). The SHP is based on total sampling and conducted biennially between March and May. Self-reports covered the seven-item Generalized Anxiety Disorder Scale; the two-item Patient Health Questionnaire for depression; the Mini Social Phobia Inventory for social anxiety; the Short Warwick-Edinburgh Mental Wellbeing Scale for mental wellbeing; loneliness; the Sick, Control, One Stone, Fat, Food measure for disordered eating; and suicidality (suicidal ideation, deliberate self-harm, and suicide attempts). Scales were dichotomised using validated cutoffs. Presence of any and comorbid mental health problems was assessed. Logistic (for dichotomised outcomes) and linear (for Short Warwick-Edinburgh Mental Wellbeing Scale) mixed effects models were used to analyse the effect of survey year on mental health, controlling for sociodemographic background factors and stratified by gender and school level. Cisgender and transgender youth were compared. Between 2015 and 2023, the SHP study recruited 722 488 students (371 634 [51·6%] girls and 348 857 [48·4%] boys) with a mean age of 15·8 years (SD 1·3) who were either in the eighth and ninth grades of comprehensive school or the first and second years of general and vocational upper secondary schools in Finland. The proportion of participants with generalised anxiety, depression, and social anxiety symptoms above the cutoff increased from pre-COVID-19 levels to 2021 and remained at these higher levels in 2023 among all study groups. Among girls in lower secondary education, prevalence of generalised anxiety, depression, and social anxiety symptoms increased from 2021 to 2023, as did social anxiety among girls in upper secondary education. Among boys, the proportion with social anxiety symptoms decreased between 2021 and 2023. Mental wellbeing scores decreased in all groups between 2021 and 2023, and disordered eating increased in girls, and in boys in lower secondary education. Suicidality increased in girls but not in boys. Loneliness was the only measure to show improvement in all groups from 2021 to 2023. In 2023, 55 895 (72·6%) of 76 994 girls and 22 718 (32·8%) of 69 205 boys reported at least one mental health problem, and 37 250 (48·4%) girls and 9442 (13·6%) boys reported comorbid mental health problems. Among both transfeminine and transmasculine youth, the prevalence of generalised anxiety and depression symptoms decreased from 2021 to 2023, but compared with cisgender youth, the proportions were significantly higher throughout. The effects of the COVID-19 pandemic on youth mental health could be long lasting. In this study, the substantial change for the better among transgender youth was a positive exception. Providing adequate support and treatment for young people with poor mental health is essential, but solutions to the mental health crisis need to address a wider societal perspective and should be developed in partnership with young people. NordForsk, Research Council of Finland. For the Finnish and Swedish translations of the abstract see Supplementary Materials section.

Lived Experiences of Parenting Transgender and Gender Nonconforming Youth: Implications for Clinical Social Work Practice

AbstractTransgender and gender non-conforming (TGNC) youth are the focus of media attention, policy and practice changes, and multidisciplinary research. Due to their disproportionate risk of self-harm, depression, and suicidality, family support of TGNC youth is a key focus. Despite growing community awareness, TGNC children, and their families, continue to navigate a complex myriad of challenges, including at an individual, family, community, and societal level. Parents are likely influenced by their child’s TGNC identity however little is known about how this parenting experience is perceived and navigated, with most research exploring the TGNC person’s perspective. Using qualitative photovoice methodology, this study explored the lived experience of raising a TGNC child from the parent perspective. Eight Australian parents of a TGNC young person aged between 10 and 18 years participated in an in-depth interview guided by their chosen photographs as the stimulus. Thematic analysis identified five key findings: 1. crossing the threshold: finding out and figuring it out; 2. changing and adapting; 3. same but different: attachment and family dynamic; 4. letting go and holding on; and 5. finding a path forward. Findings suggest complex psychosocial impacts on parenting. Recommendations include targeted support for parents that addresses grief, social isolation, career stress, and access to relevant information and services. Clinical social workers can play a vital role in supporting parents of TGNC children by providing trauma informed responses that recognise disenfranchised grief, acknowledge socioemotional impacts, and empower parents with appropriate resources to meet their needs, and those of their TGNC child.

An Intersectional Exploration of Outness, Encountered Discrimination and Violence, and Non-Suicidal Self-Injury among Asexual Youth across Gender Identities.

Current research on asexual youth is limited, especially in understanding the impact of their outness and the intersection of sexual orientation with gender minority identities. This study investigates the influence of outness on experiences of harassment, discrimination, violence, and the risk of non-suicidal self-injury (NSSI) among asexual youth, with a focus on those with transgender and non-binary identities. Data for this study were obtained from the 2021 Ace Community Survey, an international online survey designed to assess the needs and health status of the Ace community, targeting respondents aged 13 and older. The analysis involved a subsample of 5574 respondents aged 13 to 24 (mean age = 19.28), including 2361 cisgender (mean age = 19.65), 1,195 transgender (mean age = 18.80), and 2,018 non-binary individuals (mean age = 19.13). The results revealed that experienceds of sexual violence, verbal aggression, and physical harassment and bullying not only correlated with but also completely mediated the relationship between outness and NSSI. Asexual transgender youth experienced heightened levels of discrimination and NSSI but demonstrated notable resilience against the negative effects of identity disclosure, highlighting complex dynamics of vulnerability and protection within these communities.

Mental Health Needs, Barriers, and Receipt of Care Among Transgender and Nonbinary Adolescents

PurposeTransgender and nonbinary youth disproportionately experience adverse mental health outcomes compared to cisgender youth. This study examined differences in their mental health needs and supports, barriers to care, and receipt of mental health care. MethodsThis study examined cross-sectional data from 43,339 adolescents who completed the California Healthy Kids Survey, 4% (n = 1,876) of whom identified as transgender and/or nonbinary. Chi-square test and t-test were used to compare mental health needs and supports, resilience, and barriers to and receipt of care experienced by transgender and nonbinary youth compared to cisgender youth. ResultsTransgender and nonbinary youth were significantly more likely to experience chronic sadness/hopelessness (74% vs. 35%) and consider suicide (53% vs. 14%) and less likely to report resilience factors (school connectedness: mean score 3.12 vs. 3.52). Transgender and nonbinary youth were significantly less likely to be willing to talk to teachers/adults from school (12% vs. 18%) or parents/family members (21% vs. 43%), but more willing to talk to counselors (25% vs. 19%) regarding mental health concerns. Transgender and nonbinary youth were significantly more likely to select being afraid (48% vs. 20%), not knowing how to get help (44% vs. 30%), or concern their parents would find out (61% vs. 36%) as barriers to seeking mental health care, yet reported slightly higher odds of receiving care when needed (odds ratio: 1.2). DiscussionTransgender and nonbinary youth are more likely to report mental health concerns and barriers to seeking care than cisgender youth. Increasing access to care is critical for this population.

Disparities in behaviors and experiences among transgender and cisgender high school students — 18 U.S. states, 2021

PurposeTransgender youth (those whose gender identity differs from their sex assigned at birth) experience stigma and discrimination that can place them at increased risk for poor health outcomes compared with cisgender youth (those whose gender identity aligns with their sex assigned at birth). Limited population-based data exist on disparities among transgender and cisgender youth. MethodsWe examined differences in experiences of violence, substance use, mental health, suicide, sexual behavior, unstable housing, parental monitoring, and school connectedness among 98,174 transgender and cisgender high school students using data from 18 states that included an item to assess transgender identity on their 2021 Youth Risk Behavior Survey. ResultsOverall, 2.9% of students identified as transgender and 2.6% questioned whether they were transgender. Among transgender students, 71.5% reported that their mental health was not good, 32.3% had attempted suicide, and 29.0% experienced sexual violence. Transgender students were more likely than cisgender students to report experiences of violence, substance use, poor mental health, suicide risk, some sexual risk behaviors, and unstable housing, and were less likely to report feeling connected to others at school. ConclusionsInterventions that can address the causes of these adverse outcomes and promote the health and wellbeing of transgender youths are warranted.

Co-design and usability of an interactive web-based fertility decision aid for transgender youth and young adults.

To develop a patient- and family-centered Aid For Fertility-Related Medical Decisions (AFFRMED) interactive website targeted for transgender and nonbinary (TNB) youth/young adults and their parents to facilitate shared decision-making about fertility preservation interventions through user-centered participatory design. TNB youth/young adults interested in or currently receiving pubertal suppression or gender-affirming hormone treatment and parents of eligible TNB youth/young adults were recruited to participate in a series of iterative human-centered co-design sessions to develop an initial AFFRMED prototype. Subsequently, TNB youth/young adults and parents of TNB youth/young adults were recruited for usability testing interviews, involving measures of usability (i.e., After Scenario Questionnaire, Net Promotor Score, System Usability Scale). Twenty-seven participants completed 18 iterative co-design sessions and provided feedback on 10 versions of AFFRMED (16 TNB youth/young adults and 11 parents). Nine TNB youth/young adults and six parents completed individual usability testing interviews. Overall, participants rated AFFRMED highly on measures of acceptability, appropriateness, usability, and satisfaction. However, scores varied by treatment cohort, with TNB youth interested in or currently receiving pubertal suppression treatment reporting the lowest usability scores. We co-created a youth- and family-centered fertility decision aid prototype that provides education and decision support in an online, interactive format. Future directions include testing the efficacy of the decision aid in improving fertility and fertility preservation knowledge, decisional self-efficacy, and decision satisfaction.

Effects of puberty suppression on bone, body composition, handgrip strength and glucolipid profile in early-pubertal transgender adolescents

Introduction The effects of puberty suppression for more than 2 years before the start of gender-affirming hormones (GAH) on bone mass acquisition and body composition are understudied. Materials and methods Retrospective study on 46 transgender adolescents (20 trans boys and 26 trans girls) receiving a gonadotropin-releasing hormone analogue (GnRHa) from Tanner stage 2-3, followed by GAH around the age of 16 years. At start of GnRHa and at start of GAH, dual-energy X-ray absorptiometry (DXA) at lumbar spine (LS), femoral neck (FN) and total body (TB), handgrip strength test and fasting blood sampling were performed. Z-scores were calculated using reference values for both cis girls and cis boys. Results GnRHa were administered for a median of 3.2 years (± 0.69) in trans boys and 2.7 years (± 1.05) in trans girls. Bone mineral apparent density (BMAD)-LS Z-scores decreased significantly in both trans boys and trans girls, while BMAD-FN Z-scores decreased only in trans boys. Fat% and Fat Mass Index Z-scores significantly increased in both groups, while Lean Mass Index Z-scores significantly decreased. Handgrip strength Z-scores for the sex registered at birth (SRAB) remained stable in trans boys while they decreased in trans girls. There was no significant influence of the treatment on either insulin sensitivity or lipid profile. Discussion GnRHa administration for more than two years during the physiological time of puberty decreases bone mass acquisition, mainly at the lumbar spine and induces a general increase in fat mass. Although lean mass acquisition is undermined in both groups, handgrip strength is affected mainly in trans girls compared with age-matched peers for the SRAB.

Memories of schooling amongst trans women and sexuality diverse men in Papua New Guinea

ABSTRACT Drawing from a life history study we examine memories and experience of schooling in Papua New Guinea among 45 trans women and sexuality diverse men. While participants reported regulating their expression of gender and sexuality to ‘fit in’ and avoid physical and verbal abuse at school, others felt able and supported to express their gender and sexuality diversity more freely beyond stereotypical norms. Schools provided a varietyof experience for trans and sexuality diverse youth, unsupportive in many ways but supportive in others. The study highlights the importance of examining the impact of colonial discourses driving homophobia and transphobia in diverse settings, and understanding the socio-cultural climates of schools to identify solutions to the discrimination and violence experienced by trans women and sexuality diverse students. Further research into the current experiences of trans, gender and sexuality diverse young people in school would provide a valuable comparative perspective to our retrospective study.

Transgender and Gender-Diverse Child and Parent Close Relationships

Transgender and gender-diverse (TGD) children are impacted by their relationships with their parents. Parental influence can positively and/or negatively influence TGD children’s well-being. The purpose of this study is to: (a) summarize qualitative research addressing parent–TGD child relationships and (b) share these results with mental health professionals and researchers working to enhance the well-being of TGD children. We employed a qualitative metasummary to review qualitative research with findings about relationships between parents and their TGD children, with data from TGD children. We focused on parent and TGD child relationships after their initial disclosure/discovery conversations. Data collection resulted in 27 articles. Data analysis yielded three themes: parent and child together, child-specific experiences, and parent-specific experiences. This report concludes with practice implications for mental health professionals.

Let Our Stories Be Told: Conducting Narrative Inquiry with Trans Youth

ABSTRACT Today’s trans youth are being spoken at and/or for, while adults and legislators are debating and deciding how they must live their day-to-day existence. However, to best understand today’s trans youth, counselor scholars and practitioners need to hear directly from trans youth. This article provides a foundational understanding of why conducting narrative inquiry with trans youth is ethical, affirming, and a best practice. Additionally, it provides a base of understanding of what narrative inquiry’s purpose and intention is, as well as considerations for creating a rigorous, trustworthy, and credible narrative inquiry. Finally, the author addresses research biases that may exist within the process of narrative inquiry that are necessary to evaluate. Additionally, there is an increased risk to safety with minor participants who identify as transgender. There are biases within research regarding gender identity development; therefore, using a case example, the author attempts to address these concerns as elements to address throughout the entire research cycle, specifically with narrative inquiry with trans children and adolescents.

Family Matters: Exposure to Gender-Affirming or Gender-Denying Practices Following Gender Identity Milestones

This study examines the relationship between gender identity milestones, family support, and exposure to gender-affirming or gender-denying practices. Leveraging a retrospective panel from the 2015 US Transgender Survey, we compare changes in exposure to hormone replacement therapy (HRT) and conversion therapy among transgender youth who initiate gender identity milestones and those who initiate a year later–stratified by level of family support. Results indicate that transgender youth initiating milestones in supportive families have increased access to HRT and are shielded from conversion therapy, whereas children in unsupportive families have limited access to HRT and are more exposed to conversion therapy.

Eugenics, Sex and Family Life Education, and Juvenile Delinquency in Los Angeles County, California

AbstractThis glimpse into sex education in the Los Angeles region illustrates the eugenic ideas about racially “fit” reproduction that emerged in family life curricula during the Second World War. Ideas about eugenic reproduction in public schools responded to broader cultural fears about increasing divorce rates, criminality, immigration, and birthright citizenship. Eugenics in sex and family life education, importantly, portrayed a woman’s choice of mate as a civic responsibility, a move that paved the way for future conflicts about teaching gender and sexuality in public school sex education. Amid a half-century-long conflict over abstinence-only versus comprehensive sex education in public schools, topics like genetics and heredity have come to be widely accepted by both sides—recognized as a presumably value-neutral staple of sex education in US public schools. Yet recent innovations in genetic and reproductive technologies, as well as the conflict over trans and queer youth in the United States, challenge the assumption that teaching genetics and heredity in public schools really is “value neutral.”

Troubling Trends in Health Misinformation Related to Gender-Affirming Care.

Amidst the misinformation climate about trans people and their health care that dominates policy and social discourse, autonomy-based rationales for gender-affirming care for trans and nonbinary youth are being called into question. In this commentary, which responds to "What Is the Aim of Pediatric 'Gender-Affirming' Care?," by Moti Gorin, we contextualize the virulent ideas circulating in misinformation campaigns that have become weaponized for unprecedented legal interference into standard health care. We conclude that the current legal justifications for upending gender-affirming care gloss over how this health care field meets conventional evidentiary standards and aligns protocols with most other fields of medicine. Refusal to offer gender-affirming care is more harmful than centralizing trans and nonbinary people's health autonomy.

The Effects of Puberty Blocking Treatment (Gonadotropin Releasing Hormone Agonist) on Reproductive Function in Young Female Rats

The number of adolescents identifying as transgender has been increasing with many transgender youth receiving treatment with a gonadotropin releasing hormone agonist (GnRHa) that suppresses sex hormone production (i.e., puberty blocker). Transgender individuals taking a GnRHa to block puberty have reported improved mental wellbeing, but the physiological impact on reproductive function needs to be examined. Objective: To investigate the effects of puberty blocking treatment using GnRHa on reproductive morphology and function in young female rats. It was hypothesized that puberty blocking treatment would decrease fertility. Methods: Four-week old female Sprague Dawley rats were given daily subcutaneous injections of the GnRHa triptorelin or saline as control. After four weeks of treatment a group of rats were euthanized and the uterus and ovaries were removed for H&E staining to assess morphology. An additional group was taken off GnRHa treatment for 4-weeks to examine recovery of reproductive organ morphology. The final group was taken off GnRHa treatment and housed with fertile males to determine reproductive performance. Results: GnRHa treatment led to a reduction in the mass of uteri and ovaries which recovered after 4-weeks of drug withdrawal. The myometrial and endometrial thickness of the uterus was reduced in GnRHa treated animals. The ovaries of puberty blocked animals exhibited a disruption in follicle development and corpora lutea health. The morphology of the uterus and ovaries recuperated after 4-weeks of drug withdrawal. No significant difference in pregnancy rate was detected; however, both the number of days until pregnancy detection and number of days until giving birth were considerably longer in GnRHa rats following withdrawal. The number of pups per litter was also significantly reduced by puberty blocking treatment but no abnormalities were observed in the pups. Conclusion: Young female rats treated with a GnRHa had significantly delayed development of the reproductive organs. After 4 weeks of GnRHa withdrawal reproductive organ mass and morphology recovered. A minor disruption in reproductive function was detected immediately following GnRHa withdrawal. These physiological effects on reproductive health should be considered when administering a GnRHa to block puberty. No external funding was used to support this research. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Memory biases for gender-typed images in a gender-diverse group of children.

Self-socialization accounts of gender development suggest that children attend more to people of their own gender, activities associated with their own gender and stereotype-consistent examples in their environment. Evidence comes from research showing children's memory biases for such stimuli. This study sought to replicate these memory biases in 367 6- to 11-year-old transgender, cisgender and nonbinary children. Children were shown stereotype-consistent and counter-stereotypical images related to feminine- and masculine-typed activities performed by girls/women or boys/men. Results showed that transgender and cisgender children showed better recall for activities related to their own gender than the other gender. Neither group showed better recall for own-gender characters, and transgender children better recalled other-gender characters. None of the three groups better recalled stereotype-consistent than counter-stereotypical images in probed recall, although all groups showed better recall for counter-stereotypical than stereotype-consistent images in free recall. These findings provide partial support for self-socialization accounts of gender development.

Troublemakers: Young people as unruly activists in an anti-trans US school context

This piece of comics-based research (CBR) tells the story of young people’s activism and adult lassitude in progressive US communities where the transgender and nonbinary youth had seemed well supported, but were in fact targeted by school staff at two middle-grade schools. While there ensued various forms of protest and activism, adults encouraged children to engage in adult-curated, docile forms, such as making chalk art on the sidewalk in front of the middle school, or writing letters to administration. Many young people refused these forms and instead used “unruly” forms of activism. These included defacing school spaces and other means of disrupting institutional functioning. They saw adult-curated docile activism as a frustratingly inert treatment. Even in such a clear situation, many adults seemed still more uncomfortable with unruly activism, cast as “troublemaking” than with adult transgressions, and refused to see the children as anything other than improper. This comic describes children’s unruly activism in the context of adult violence and adult-curated docile activism as a form of control—and reflects on adult discomfort as a fulcrum of complex power. Reflections on reframing all child “misbehavior” as radical action conclude the comic narrative.

Major MH disparities found among trans vs. cis youth

Despite broad improvements in attitudes toward gender minorities, a new study examining mental health disparities in transgender individuals compared to the cisgender population has found alarming increases over several years, prompting researchers to call for new policies to address the worsening mental health of transgender and gender nonconforming people in the United States.