Transgender And Gender-diverse Youth Research Articles

High Internalized Transphobia and Low Gender Identity Pride Are Associated With Depression Symptoms Among Transgender and Gender-Diverse Youth

PurposePrior studies have identified a significant relationship between internalized transphobia and poor mental health among transgender and gender-diverse (TGD) adults; however, this relationship has not been extensively examined among youth. Further, little research has sought to explore protective factors, such as identity pride, and their influence on this relationship. We examined the association between internalized transphobia and depression and anxiety symptoms among TGD youth and explored the moderating role of gender identity pride on these associations. MethodsParticipants were 315 TGD youth ages 12–20 years (mean = 16; standard deviation = 1.89) seeking gender-affirming hormone treatment at one of four major pediatric hospitals across the United States. At the time of enrollment, participants were naïve to gender-affirming hormone treatment. Participants self-reported mental health, internalized transphobia, and identity pride. Multiple regression models were used with depression and anxiety symptoms as outcomes and age, designated sex at birth, and perceived parental support included as covariates. ResultsGreater internalized transphobia was associated with greater depressive symptoms, and gender identity pride moderated this relationship, such that greater gender identity pride was associated with fewer depressive symptoms. Greater internalized transphobia was significantly associated with greater anxiety symptoms; no moderation effect was observed for this relationship. DiscussionGender identity pride influenced mental health symptoms for youth experiencing internalized transphobia and represents a potential key protective factor. These results support efforts to further develop, test, and implement clinical inventions to bolster identity pride for TGD youth.

Transgender and Gender Diverse Youth’s Perspectives of Affirming Healthcare: Findings From a Community-Based Study in Kansas

Transgender and gender diverse (TGD) youth experience disproportionate rates of stigma and discrimination, contributing to health concerns. TGD people also report limited access to affirming healthcare, yet little is known about TGD youth and affirming healthcare in the Midwestern U.S. We utilized a community-based, mixed methods survey to explore the health and healthcare experiences of TGD youth in Kansas. Participants ( n = 89) were predominantly non-binary (49.4%) and transgender boys/transmasculine (28.1%). Approximately 20% reported discrimination by a healthcare provider and half reported at least one affirming experience (58.5%). Affirming practices included providers using correct names and pronouns (43.1%), asking about gender (38.4%), facilitating access to gender-affirmative healthcare services (20.0%), and connecting to TGD resources (18.5%). Thematic analysis of open-ended responses revealed contextual details about TGD youth’s experiences. These findings are relevant to medical and mental health providers, as well as advocates training providers to offer more accessible and affirming care for TGD youth.

Psychiatric Boarding of Transgender and Gender Diverse Youth Awaiting Treatment.

With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients' psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.

“I’m proud to be myself”: A qualitative investigation of identity-related emotions among transgender youth

ABSTRACT Transgender and gender-diverse youth (TGDY) experience elevated rates of discrimination and victimization. Recent empirical and theoretical work with sexual minority adolescents (e.g., lesbian, gay, bisexual or pansexual) propose negative emotions result from these adverse experiences and are managed through deleterious health behaviors and that experiences of resilience contribute to positive emotions managed through promotive health behaviors. However, the role of identity-related emotions of TGDY has yet to be explored in a health framework. The current study utilizes past empirical and theoretical research to examine the construction of identity-related emotions for TGDY in the Midwest using a deductive-inductive thematic analysis with a priori and data-driven codes. Nineteen youth between the ages of 15–22 (M = 18, SD = 2.29) from two Midwestern states participated in the study. Study procedures and preliminary analysis were overseen by a TGDY advisory board. Seven discrete emotions emerged from the thematic analysis. Consistent with prior research, emotions emerged from a confluence of TGD identity experiences, perceptions of self, and the social environment. Emotions were managed through behaviors that have implications for health. Future prospective studies should test findings among a large, demographically diverse population of TGDY. Furthermore, practitioners should find ways to reduce the occurrence and impact of negative identity-related emotions while supporting the construction of positive ones.

Telemedicine Utilization Among Transgender and Gender-Diverse Adolescents Before and After the COVID-19 Pandemic.

Introduction: Little is known about how expansion of telemedicine services during the COVID-19 pandemic has affected access to gender-affirming care for transgender and gender-diverse (TGD) youth. The purpose of this study was to explore differences in demographic characteristics and visit completion rates at a multidisciplinary gender clinic before and after telemedicine implementation in March 2020 and among telemedicine users and nonusers. Methods: Data were from electronic health records of Seattle Children's Gender Clinic (SCGC) patients seen between April 2019 and February 2021. We assessed differences in demographic characteristics and care utilization (i.e., encounter type and status) between April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine). Results: Of the 1,051 unique patients seen at SCGC during this time period, majority groups were as follows: 62% identified as transmasculine/male, 68% were non-Hispanic White, and 76% resided within 50 miles of the clinic. Statistically significant differences were observed in patient pronouns and insurance type when comparing the pre- and post-telemedicine periods (p < 0.01). Half (52%) of post-telemedicine period encounters were conducted through telemedicine, and telemedicine encounters were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Conclusions: Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. Although the introduction of telemedicine did not exacerbate demographic disparities in access to this care, further research and interventions are warranted to address the ongoing disparities in access to gender-affirming care for youth of color and rural youth.

Understanding Transgender and Gender-Diverse Youth's Experiences Receiving Care via Telemedicine: Qualitative Interview Study.

Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine. The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.

Gender Dysphoria: Optimizing Healthcare for Transgender and Gender Diverse Youth with a Multidisciplinary Approach.

Transgender and gender diverse (TGD) youth and their families are seeking medical and mental health care at increasing rates. As the number of multidisciplinary pediatric gender programs expands, we consider the history and evidence base for gender affirmative care and highlight existing models of care that can flexibly accommodate the diverse needs of TGD youth and their families. Comprehensive multidisciplinary care includes both medical and mental health providers who work collaboratively with TGD youth and their caregivers to assess gender-related support needs and facilitate access to developmentally appropriate medical and mental health interventions. In addition to direct health-care services, multidisciplinary care for TGD youth and their families extends into community training, education, community outreach, nonmedical programming, and advocacy for TGD youth.

Practices for Promoting Affirming Health Care for Transgender and Gender Diverse Youth.

Transgender and gender diverse (TGD) youth, particularly transgender youth of color, experience barriers to most, if not all, types of care across the United States. Consequently, clinicians are concerned about the increase of anti-transgender policies in the United States, with many states now restricting gender-affirming care. In this manuscript, we suggest several empirically based techniques to provide quality clinical care. We also share resources to support TGD youth and their families, while accommodating for some of these newer restrictions on the care that clinicians are able to provide. Ongoing training and awareness in these techniques will allow clinicians and their health care institutions to more effectively and immediately respond to anti-transgender policies and be able to provide care. By continuing to advocate for some of these strategies, there is potential to reduce the health inequities that many TGD youth experience. Prioritizing screening for gender discrimination, creating a safe space for TGD youth, and providing immediate clinical strategies to reduce distress can reduce symptoms of depression and suicide. These changes, albeit small, will allow clinicians to feel more comfortable providing gender affirming care through holistic changes in clinical practices and care.

Mental Health of Transgender and Gender Diverse Youth.

Transgender and gender diverse (TGD) children and adolescents are an increasingly visible yet highly stigmatized group. These youth experience more psychological distress than not only their cisgender, heterosexual peers but also their cisgender, sexual minority peers. In this review, we document these mental health disparities and discuss potential explanations for them using a minority stress framework. We also discuss factors that may increase and decrease TGD youth's vulnerability to psychological distress. Further, we review interventions, including gender-affirming medical care, that may improve mental health in TGD youth. We conclude by discussing limitations of current research and suggestions for the future.

Collaborating with transgender youth to educate healthcare trainees and professionals: randomized controlled trial of a didactic enhanced by brief videos

BackgroundIn collaboration with members of the transgender and gender diverse (TGD) community, we created a didactic resource about the unique needs of TGD youth.MethodsWe developed teaching materials enhanced by video clips of two TGD adolescents openly sharing aspects of their lived experience. We compared the video and no video conditions in a randomized controlled trial (RCT) in which participants were assigned to one of four parallel conditions: 1) a transgender [TgV] or 2) a cisgender [CgV] woman presenting with videos embedded into the presentation, 3) the same cisgender woman presenting without the videos [CgN], or 4) a no intervention control [NiC]. Our primary outcome was change in the total score of the Transgender Knowledge, Attitudes, and Beliefs Scale (T-KAB).ResultsWe recruited and proportionally randomized 467 individuals, 200 of whom completed ratings before and after the intervention: TgV (n = 46), CgV (N = 46), CgN (n = 44), and NiC (n = 64). Mean scores on all measures of TGD acceptance increased in the video group, compared to the no video group. Improvements persisted after 30 days (p < 0.01), except on perceptions about TGD family members. The three active intervention groups did not differ in efficacy.ConclusionsThese findings provide empirical evidence that a well-informed presenter, regardless of their gender, can achieve similar improvements in perceptions and knowledge about TGD youth when using a resource that can be disseminated free of cost.

Decision Support Needs for Transgender and Gender-Diverse Youth and Families: A Patient-Centered Needs Assessment

PurposeDue to the intertwining of medical and social decision-making, new approaches to shared decision-making are likely needed for supporting decisions related to the care of transgender and gender-diverse (TGD) adolescents. Prior to developing decision support interventions for TGD youth, a decision support needs assessment must be completed. MethodsSelf-identified TGD youth, family members of TGD youth, clinicians caring for this population, and community advocates participated in one of six group level assessments (GLAs). GLA is a structured, participatory qualitative method that engages diverse groups of stakeholders in generating and evaluating ideas on the topic of interest. Upon completion of all GLAs, a survey was developed and distributed to GLA participants inviting them to rank ideas generated during the GLAs. ResultsSix major themes emerged from the GLAs regarding decision support needs, including: improving healthcare provider skills and education, increasing access to support outside the healthcare system, strengthening community and societal support, developing special information resources, supporting youth in leading decision-making about transition, and modifying the healthcare system. In the follow-up survey, improving healthcare provider skills and education was the most commonly chosen top priority. DiscussionParticipants identified decision support needs for TGD youth and their families that were mostly distinct from traditional decision support approaches. Participants' focus on the need to improve healthcare provider skills and education provides an opportunity to couple gender-focused education with shared decision-making skills, an approach that may be more sustainable than tools for specific decisions.

Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study.

While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research. A total of 108 TGD youth ages 16-24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit. Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health-e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)-and elevated rates of illicit drug use (19-85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57-67% reported sex without a condom). This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization.

Geographic Distribution of Clinical Care for Transgender and Gender-Diverse Youth.

Geographic barriers limit access to clinical care in the United States for transgender and gender-diverse (TGD) youth. Some factors differentiating access to care are variability in state laws/policies, the number of available clinical care programs and mental health providers for TGD youth. We aggregated data from the Human Rights Campaign for pediatric clinical care programs for TGD youth, the Movement Advancement Project for state-by-state assessment of gender identity laws and policies, and Psychology Today for mental health providers for TGD youth by state. Current prevalence rates for TGD youth were applied by state with 2020 Census data. Findings were summarized as a whole and per capita by state, region, and country overall. The South has the highest number of TGD youth per clinic (36 465-186 377), and the lowest average equality score in gender identity laws and policies (1.96). The Midwest has the highest number of TGD youth per mental health provider (278-1422). The Northeast has the lowest number of TGD youth per clinic (11 094-56 703), the highest average equality score in laws and policies per state (17.75), and the highest average number of TGD youth per mental health providers (87-444). Findings support there are barriers to TGD youth care throughout the United States, especially the South and Midwest. Increasing medical and mental health care for TGD youth is likely to improve their health and well-being. Enacting gender identity protective laws/policies would allow for equal treatment and access to care among TGD youth.

Leuprolide Acetate for Puberty Suppression in Transgender and Gender Diverse Youth: A Comparison of Subcutaneous Eligard Versus Intramuscular Lupron

PurposeTo compare the efficacy of intramuscular Lupron and subcutaneous Eligard, two formulations of leuprolide, for puberty suppression in transgender and gender diverse (TGD) youth. MethodsA retrospective chart review of TGD youth receiving Lupron or Eligard 22.5 mg every 3 months was conducted to determine hormone levels obtained 1 hour after an injection (1hrPost) and patient-reported clinical puberty suppression. ResultsForty eight patients were analyzed: 33% assigned female at birth of which 25% were premenarchal, mean age at first injection 13.7 years, and 50% received concurrent gender affirming hormones. Of these, 13% received Lupron, 52% Eligard, and 35% initially received Lupron then transitioned to Eligard due to drug shortages. There were 55 incidents of 1hrPost levels, 42 after Eligard and 13 after Lupron. Clinical puberty suppression occurred in all patients; however, biochemical suppression occurred in 90% of Eligard and 69% of Lupron (p = .06). DiscussionEligard and Lupron were both effective in suppressing clinical puberty progression in our population of TGD youth, of which 50% were receiving concurrent gender affirming hormones.

“You can’t be deadnamed in a video game”: Transgender and gender diverse adolescents’ use of video game avatar creation for gender-affirmation and exploration

Transgender and gender diverse (TGD) adolescents experience mental health challenges at higher rates than cisgender peers due to a combination of minority stress and gender dysphoria. Many TGD youth use video games to cope with stress and access informal networks of support. However, very little is known about the potential positive influence avatar customization has for this group of youth. To address this gap in the literature, in-depth, semi-structured qualitative interviews were conducted with ten TGD adolescents about their experiences with avatar customization. Thematic analysis revealed four primary themes including that (1) video game avatar customization offers a low stakes environment for gender exploration, (2) avatars offer both internal and external validation of gender identity and transition goals, (3) avatars allow players to enact aspirational appearance goals, and (4) video games and avatars offer immersion and escapism for TGD adolescents. These novel findings underscore the range of positive impacts avatar customization can have for TGD adolescents, particularly for youth with gender dysphoria. Video game avatar customization can be a key part of the gender exploration and affirmation for some TGD adolescents.

Structural and school factors, affirmation and well-being among gender minority youth across Europe

Abstract Background Previous research has shown that structural-level factors (discriminatory laws and policies) result in impaired health and well-being for transgender and gender diverse (TGD) adults. This study aims to assess if structural stigma is associated with school bullying/victimization and well-being among TGD youth and if more LGBTI supportive school environments, as well as social, physical, and legal gender identity affirmation ameliorate the effects of both structural stigma and experiencing violence. Methods The study was conducted online in 2019 in 27 EU Member States and in the UK. We analyzed data from TGD students, aged 15 to 24 years, who at most had completed lower secondary education (n = 2,714). Well-being indicators used in the analyses included one-item measures of life satisfaction, depression, and considering leaving or changing school. Results School environment, but not structural-level stigma, was associated with school bullying/victimization. Similarly, the effects of structural-level stigma, along with physical and legal gender identity affirmation were inconsistently related to students’ well-being across the multilevel models, whereas a more positive school environment and especially experiences of social identity affirmation were related to greater life satisfaction, better mental health, and lower odds of considering leaving or changing school; even though the negative effects of school bullying/victimization remained statistically significant across all models. Conclusions This study's results suggest that compared with distal factors, more proximal factors - better school environment and social identity affirmation - have a greater impact on TGD students’ well-being. Given the inconsistency of our findings, more research is needed to understand the role of structural stigma and legal and physical gender identity affirmation in TGD students’ well-being.

Gender-Affirming Care of Transgender and Gender-Diverse Youth: Current Concepts.

Increasing numbers of transgender and gender-diverse (TGD) youth, from early puberty through late adolescence, are seeking medical services to bring their physical sex characteristics into alignment with their gender identity-their inner sense of self as male or female or elsewhere on the gender spectrum. Numerous studies, primarily of short- and medium-term duration (up to 6 years), demonstrate the clearly beneficial-even lifesaving-mental health impact of gender-affirming medical care in TGD youth. However, there are significant gaps in knowledge and challenges to such care. Long-term safety and efficacy studies are needed to optimize medical care for TGD youth.

Dialectical behaviour therapy (DBT) for high-risk transgender and gender diverse (TGD) youth: A qualitative study of youth and mental health providers' perspectives on intervention relevance.

Despite the significant mental health challenges and unique treatment needs of transgender and gender diverse (TGD) youth, research on the acceptability of evidence-based treatments for these youth is limited. To address this gap, the current study explored the perceived relevance of dialectical behaviour therapy (DBT) for high-risk TGD youth. Qualitative data were collected from six focus group discussions with a purposive sample of 21 TGD youth aged 18-25 years old who endorsed a history of depression, suicidality or self-harm and individual interviews with 10 mental health treatment providers with prior DBT and TGD client experience. The data were analysed inductively using thematic content analysis. The results highlighted the perceived relevance of DBT in targeting chronic and acute stressors, some of which are unique to TGD youth such as issues related to gender dysphoria, hormone-related treatment and gender identity. Possible areas for treatment modifications including the adaptation of body awareness exercises and physiological-related coping techniques for youth experiencing gender dysphoria, and the reinforcement of self-care skills, were identified. While interpersonal effectiveness skills were acknowledged as important, treatment providers highlighted a need to prioritize safety over the practice of these skills. This is because TGD youth often experience more hostile and prejudiced interpersonal experiences than their cisgender peers. The study's findings shed light on previously unexplored perspectives of TGD youth and treatment providers on the perceived relevance of DBT and provide treatment providers and implementation researchers with some critical issues to consider when working with high-risk TGD youth.

Management of acne in transgender and gender diverse youth part 1: Gender affirming care and risk factors for the development of acne.

Acne vulgaris is among the most common skin disorders afflicting adolescents worldwide, and though well-established guidelines of care exist for acne management, these guidelines do not uniformly consider or address the unique psychosocial and medical needs of transgender and gender diverse (TGD) youth. TGD youth may possess distinct goals of therapy when treating their acne; the use of medicines routinely employed to treat acne may also expose TGD adolescents receiving gender affirming medical therapy to greater risk of adverse events. Part 1 of this two-part review provides dermatologists an understanding of gender affirming care and its timing, as well as its potential impacts on the development of acne in TGD youth.

Fertility Considerations in Parental Decision-Making about Pubertal Suppression Treatment for Their Transgender and Gender-Diverse Children

Transgender and gender diverse (TGD) youth receiving pubertal suppression treatment may be at risk for future infertility if they progress on to gender-affirming hormones. Little is known about whether and how parents of TGD youth consider fertility-related implications when making medical decisions about pubertal suppression treatment. We conducted interviews with 13 parents of 11 TGD youth about fertility-related considerations in the context of treatment decision-making. Three major themes were identified: (1) current fertility knowledge and counseling experiences, (2) barriers to parent–child discussions around fertility, and (3) importance of fertility in treatment decision-making. Findings highlight the complex nature of fertility considerations in this population.