Transgender And Gender Nonconforming Youth Research Articles

White American transgender adults' retrospective reports on the social and contextual aspects of their gender identity development.

A growing body of research has attended to the experiences of transgender and gender non-conforming (TGN) youth's gender identity development. However, practical and ethical concerns have impeded our ability to understand the experiences of TGN youth. Thus, the aim of this study was to utilize one-on-one semi-structured interviews to explore White American TGN adults' (N = 15) retrospective accounts of their gender identity development in childhood and adolescence. Findings demonstrate considerable heterogeneity in TGN adults' retrospective accounts of their gender identity development. However, TGN adults consistently highlighted the role of social (e.g. friends, family and teachers) and contextual (e.g. online, offline, educational and geographical) factors in their gender identity journeys. This study provides new insight into the role of social and contextual factors in TGN adults' retrospective accounts of their gender identity development, demonstrating the importance of continuing to examine these factors in gender diversity research.

Protective factors for transgender and gender non-conforming youth’s high school experience: a systematic literature review

This systematic review provides an overview of the empirical research relating to protective experiences of transgender and gender non-conforming (TGNC) high school students. 22 studies were identified by online search which included protective high school experiences and TGNC youth. Results revealed an increasing trend of publication in this field after 2010, with the majority of these studies conducted in the U.S. The reviewed studies showed that interpersonal support from friends and educators played a critical role in shaping TGNC students’ affirming school experiences. In addition, TGNC students themselves demonstrated resilience to cope with hostile school experiences and even promoted a more inclusive environment. A safe school environment with accessible resources for TGNC students was also critical for both their mental and academic outcomes. Depending on the context and intersecting identities of TGNC youth, however, protective factors and affirming experiences continue to be rare. The review concludes with recommendations for research and practice.

Disordered eating in transgender and gender non-conforming youth: A comparison to community-based and clinical samples.

This study investigates eating pathology in transgender and gender non-conforming (TGNC) youth compared to a community-based sample and individuals with eating disorders (EDs). Participants (ages 13-21years) included TGNC youth from a paediatric gender clinic (N=97), a demographically matched community-based sample of cisgender males (N=97) and cisgender females (N=97), and treatment-seeking patients with EDs (N=112). The Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED cognitions and behaviours. Transgender and gender non-conforming participants reported significantly higher EDE-Q global scores compared to the cisgender samples, but significantly lower than the ED sample. Transgender and gender non-conforming individuals reported a higher likelihood of objective binge episodes (OBEs) than the cisgender groups, albeit lower than youth with EDs. A substantial proportion of TGNC participants scored in elevated ranges on the EDE-Q global score (35%≥score of 3, 17%≥score of 4), significantly higher than cisgender males (0%≥score of 3, 0%≥score of 4) and females (9%≥score of 3, 3%≥score of 4). Findings indicate that TGNC youth exhibit increased ED cognitions and OBEs compared to cisgender samples, highlighting the need for screening and addressing ED symptoms in this population.

A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic.

Youth who identify as transgender and gender nonconforming (TGNC) are at increased risk of anxiety, depression, bullying, and loss of social and family support. These factors may increase the risk of developing functional neurologic disorder (FND). If the risk of FND is increased in TGNC youth, then identifying which youth are at increased risk, and the particular times when risk is increased, may allow for earlier diagnosis and treatment of FND. Better awareness of functional symptoms among clinicians who care for TGNC youth may prevent disruption of gender-affirming care if FND symptoms emerge. Patients diagnosed with FND who are TGNC may require different forms of intervention than other youth with FND. We present 4 cases from our multidisciplinary pediatric FND program of TGNC youth who developed FND. In all individuals for whom follow-up information was available, access to gender-affirming health care was associated with marked improvement or resolution of FND symptoms.

Spirituality, Religion and Transgender and Gender Nonconforming Affirmative Care with Youth and Families: Guidelines and Recommendations.

An increasing number of transgender and gender nonconforming (TGNC) youth are seeking gender-affirming medical treatments and affirmative mental health supports. The field currently lacks guidelines or recommendations for the integration of spirituality and religion into such care. Providers must consider spirituality and religion when working with this population because it may reduce the burden of adversity and may also improve the likelihood of positive outcomes among this population. Informed by an adapted version of the Minority Stress Model and the cultural humility framework, our manuscript details recommendations for interdisciplinary care with TGNC youth and families in the following areas: functional assessment of spirituality and religion as they relate to gender identity, parental support, medical decision making, coping; religious/spiritual referral; psychotherapy referral; and community advocacy. Recommendations offer providers in interdisciplinary settings applicable frameworks and guidelines for integrating spirituality and religion into care with TGNC youth and families.

48. Hospitalization for Suicide Attempt and Self-Harm Among Youth Diagnosed With Gender Dysphoria

Transgender and gender non-conforming (TGNC) youth experience severe discrimination which has been linked to adverse mental health outcomes, including an increased prevalence of suicidality and self-harm. Few epidemiological studies have examined this relationship; thus, we studied the relationship between hospitalization for suicidality, self-harm and gender dysphoria in a large, nationally representative database. We used the 2016 Kids’ Inpatient Database to identify a subset of TGNC youth < 21 years of age captured by the database (using ICD-10 gender dysphoria-related codes). We identified suicidal ideation or suicide attempt using either explicit “suicidality” codes, or one of 355 distinct self-harm codes. Using descriptive statistics, prevalence of suicidality and self-harm was compared between youth with and without gender dysphoria. A multivariable logistic regression model adjusting for individual, admission and hospital-level variables was constructed looking for association between gender dysphoria and suicidality. The cohort included 3,115,589 subjects, of whom 1,980 (64 per 100,000 admissions) had gender dysphoria. Analysis of demographic variables revealed the gender dysphoria diagnosis group was comprised of a disproportionately lower proportion of non-white, publicly insured, and low median income young adults compared to the entire cohort. Prevalence of suicidal ideation and suicide attempt in the entire cohort was 2%, compared to 35.3% in young people with gender dysphoria. Using the expanded definition of self-harm and attempted suicide, prevalence increased to 44.1%. After adjusting for individual, admission and hospital-level variables, subjects with gender dysphoria had 7.89 increased odds of attempted suicide or suicidal ideation (95%CI: 7.09-8.79). Using a large and representative database, we found significantly higher prevalence of suicide attempt and self-harm in hospitalized youth with a gender dysphoria-related diagnosis. For youth hospitalized after suicide attempt or self-harm, gender-affirming care and inclusive language is essential to reduce psychological stress secondary to physician-mediated interpersonal discrimination. Importantly, this study only captured TGNC youth with a formal gender dysphoria diagnosis, and not all youth who identify as TGNC have a diagnosis or disclose their identity; thus, the results should not be generalized to the entire population of TGNC youth. Furthermore, there were fewer non-white, publicly insured, and low median income youth with a gender dysphoria diagnosis compared to the entire cohort, which suggests inequities in accessing gender-affirming care among racial minority and economically disadvantaged youth. The results of this study highlight the need for structural interventions and policies to reduce discrimination and improve access to gender-affirming care in order to prevent these adverse outcomes.

Early Reactions of Parents to Their Trans and Gender Non-Conforming Children

Pre-adolescent transgender and gender non-conforming (TGNC) youth who are supported by their parents have improved psychosocial outcomes. Despite the important role parents play in TGNC youth’s development, there is little research on their experiences. This study explored the early parenting experiences of 34 parents of pre-adolescent TGNC youth. Parents were recruited from online communities and listservs, and interviewed via phone about their early parenting experiences. Data were analyzed via thematic analysis. Findings indicate that parents became aware of their child’s TGNC identity either through observing their child’s gender behaviors, or by their child verbalizing their identity. Parents, on average, became aware of their child’s gender identity exploration when they were just over 3 and a half years old. Parents felt a mix of emotions, with many reporting a lack of concern or positive emotions regarding their child’s rejection of traditional gender roles. Parents without prior knowledge of transgender people or existing connections to lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people sought out information from the Internet. The findings are both consistent with and diverge from prior research with parents, suggesting both new areas for research, and additional ways in which TGNC youth and their parents can be best supported.

Negotiating Gender in Everyday Life: Toward a Conceptual Model of Gender Dysphoria in Adolescents

A growing number of adolescents are seeking medical care to alleviate gender dysphoria (GD). This qualitative study explored the subjective experiences of GD among help-seeking transgender and gender nonconforming (TGNC) youth in order to develop a more nuanced conceptualization of the phenomenon. Fifteen life-mode interviews were conducted with newly referred youth between the ages of 13 and 19. All participants were assigned female at birth. The data were analyzed using thematic analysis. The participants targeted five major themes that characterize GD: (1) Bodily sensations were constant reminders of GD throughout the day, (2) emotional memories from the past of being different and outside triggered GD, (3) the process of coming out was a transformative experience that changed how the participants understood themselves, (4) GD both increased and decreased in relation to others, (5) everyday life required careful negotiation to feel whole without developing new forms of GD. Based on the results, we suggest a more conceptually nuanced model of GD, one which accounts for how bodily sensations and emotional memories from the past were sources that elicited GD. The sources were mediated through the process of coming out and relating to others, and this resulted in the negotiation of GD today. The conceptual model suggested in the present study could ideally shed light on preexisting knowledge on TGNC youth struggling with GD. In addition, an improved understanding of GD could ideally help clinicians when addressing individual treatment needs.

38.7 Retrospective Study of Characteristics of Transgender and Gender-Nonconforming Adolescents Admitted to an Inpatient Psychiatric Unit Compared to Cis-Gender Adolescent Inpatients

The number of transgender and gender-nonconforming (TGNC) youth presenting to outpatient medical services has increased. Alarmingly, TGNC youth are at greater risk for depression, suicide attempts, completed suicide, self-injurious behaviors, and substance abuse compared to cisgender adolescents. This research suggests that understanding factors that influence the development of TGNC adolescents is important. Few studies have targeted TGNC youth admitted to a psychiatric unit. This can be a critical experience in the youth's treatment trajectory. The purpose of this study is to examine characteristics, treatment histories, and trauma histories of adolescent inpatient TGNC psychiatric patients compared with cisgender inpatients. A retrospective chart review was done on all adolescent admissions to a university inpatient psychiatric unit in 2012 and 2017 (n = 432; mean age 15 years old). Data abstracted from the medical record included age, ethnicity, sex assigned at birth, gender identity, sexual preference, trauma history, bullying experiences, psychiatric diagnoses, psychiatric treatment, family psychiatric history, rural vs urban home environment, and religious preference. χ2 and Fischer’s exact tests were used to examine associations between these data points. For both years, 53.8% of nonbinary adolescents reported psychiatric comorbidity, 30.8% experiencing bullying, 30.8% history of suicide attempts, and 61.5% histories of self-harm behavior. There was a positive association between nonbinary and comorbidity (p = 0.019), being bullied (p = 0.006), suicide attempt (p = 0.009), self-harm (p = 0.000), aggression (p = 0.004), and legal issues (p = 0.011). The results were consistent between the 2 years and significantly greater than the cisgender inpatients. Many adolescents who identify as transgender or who are questioning their identity exhibit concerning mental health consequences. Understanding characteristics of adolescents who enter psychiatric inpatient facilities may help educate community-based providers to better understand the unique needs of this group. The inpatient unit experience could potentially impact these youth moving forward in their treatment, and it is important for the treatment team to be aware of their vulnerabilities.

Effects of the COVID19 Pandemic on Transgender and Gender Non-Conforming Adolescents’ Mental Health

We assessed the effects of the COVID19 lockdown on the mental health of transgender and gender non-conforming (TGN) youth (n = 18) vs cisgender youth (29 males; 29 females). Coronavirus Health Impact Survey (CRISIS) and Emotion Regulation Questionnaire were used in an online study. No group differences were found in demographic variables and exposure to COVID19. Negative emotions/feeling increased for all groups. Cisgender youth reported using more adaptive emotion regulation strategies than TGN youth. While the lockdown similarly affected TGN and cisgender youth, the former showed elevated levels of symptomatology and fewer adaptive emotional regulation strategies.

Gender Minority Stress, Support, and Inflammation in Transgender and Gender-Nonconforming Youth.

Purpose: Transgender and gender-nonconforming (TGNC) youth often report higher rates of chronic social stressors such as victimization, discrimination, and rejection. Some of these gender-based stressors may have long-range physical health consequences through inflammation pathways. This study evaluates the feasibility and acceptability of adding biological measures of inflammation to an ongoing prospective clinical study of TGNC youth (ages 9-20 years), initiating affirming medical therapy at a large, urban children's hospital (N=56). We also examine the relationship between gender-based sources of stress and support with inflammation. This is the first study to explore how gender identity, social stressors, and social supports may contribute to poorer health in TGNC youth through inflammation and immune dysregulation pathways. Methods: Between October 2016 and August 2018, the study team collected dried blood spot (DBS) samples and health measures during clinical visits. Participants also completed computer-assisted surveys assessing gender minority stress and support during these visits. We used regression analysis to evaluate differences in C-reactive protein (CRP) controlling for demographics, health, gender-based stress, and supports. Results: The results from this study indicate that adding DBS samples to assess inflammation was feasible and acceptable in a clinical sample of TGNC youth seeking affirming-medical interventions. We found an association between greater inflammation and the composite score for greater gender-based stressors and lower gender-based supports using the Gender Minority Stress and Resilience Tool (GMSR); however, we did not find statistically significant differences in CRP associated with any of the individual GMSR subscales assessing various types of gender-based supports or stressors. Conclusion: More research is necessary to evaluate how different sources of gender-based support and stress relate to inflammation with larger sample sizes.

Experiences of Parent-Advocates of Trans and Gender Non-Conforming Youth

There is a need for more research on the experiences of affirming parents of pre-adolescent transgender and gender non-conforming (TGNC) children. This study explores how parents conceptualized advocacy roles. Eleven parents of TGNC children age 13 and under completed semi-structured phone interviews. Ten parents considered themselves advocates, with digital advocacy being the most common. Advocacy motivations centered around parental concerns. Parents were divided on whether advocacy helped or had no impact on the parent-child relationship. The largest-shared concern was over the right to privacy. These findings have implications for mobilizing parents of TGNC youth as advocates.

Risk and Resilience Factors for Mental Health among Transgender and Gender Nonconforming (TGNC) Youth: A Systematic Review.

In recent years, there has been a proliferation of research regarding transgender and gender nonconforming (TGNC) people. The stigma and legal discriminations that this population faces have obvious and documented repercussions for mental health. In 2015, the American Psychological Association (APA) published Guidelines for Psychological Practice with TGNC People. The APA noted that due to the nuances of working with TGNC youth and the dearth of related literature, the guidelines focus primarily on TGNC adults. To date, there has not been a systematic review of risk and resilience factors for mental health among TGNC children, adolescents, and young adults under the age of 25. Forty-four peer-reviewed articles met inclusion criteria for this systematic review, and were evaluated for their methodological rigor and their findings. Common risk factors for negative mental health variables included physical and verbal abuse, exposure to discrimination, social isolation, poor peer relations, low self-esteem, weight dissatisfaction, and age. Across studies, older children and adolescents tended to report higher rates of psychological distress. Resilience-promoting factors for mental health were also documented, including parent connectedness, social support, school safety and belonging, and the ability to use one's chosen name. By synthesizing the existing literature using a resilience-focused and minority stress framework, the present review provides clinicians and researchers with a coherent evidence-base to better equip them to promote psychological adaptation and wellbeing among TGNC youth.

Pediatric nurse practitioners' attitudes/beliefs and knowledge/perceived competence in caring for transgender and gender-nonconforming youth.

There is a growing number of youth and their parents seeking assistance from care providers related to gender dysphoria and transitional care for transgender and gender-nonconforming(TGNC) youth. The purpose of this study was to determine pediatric nurse practitioners' (PNP) attitudes/beliefs and knowledge/competence in caring for TGNC youth. This cross-sectional descriptive study surveyed PNPs (N = 93) from eight states using two survey instruments to measure attitudes and beliefs and knowledge and perceived competence related to caring for TGNC youth. Eighty-one percent of PNPs reported caring for TGNC youth in their practice. Despite this, only 15% of the PNPs received education related to transgender patients during their advanced practice education. Results showed that attending continuing education offerings related to caring for TGNC patients increases PNP perceived competence as well as knowledge. Attitudes and behaviors towards the transgender population were also more positive if the PNP had attended continuing nursing educationofferings. Three themes emerged from a qualitative portion of the survey, asking the participant to share thoughts related to caring for transgender youth: lack of education for healthcare providers, the need to refer patients to comprehensive gender services, and the need for support for transgender patients and their families. Education plays an important part in nurses' attitudes, beliefs, and perceived competence in caring for transgender patients. Because the PNP is likely to be exposed to patients with TGNC, it is imperative they seek out opportunities to learn about transgender issues and caring for transgender patients.

“If Extended Family Can’t Deal…” Disclosing Trans and Gender Non-Conforming Children’s Identity

Parents are core decision-makers and advocates for their pre-adolescent transgender and gender non-conforming (TGNC) children, yet there is a dearth of research on their experiences, particularly their relationships with extended family members. This study explored how parents make decisions of whether or not to disclose their children’s TGNC identity to extended family members. In Phase 1, 34 parents of TGNC youth under the age of 13 described in interviews their experiences pertaining to disclosure of their child’s TGNC status to extended family members. Phase 2 replicated and expanded these findings with 11 additional parents. Across both phases, two disclosure processes were identified: casual unfolding disclosure, where parents allowed extended family members to witness their child’s TGNC identity development, or explicit direct disclosure, in which parents wrote mailed or emailed letters to help organize their thoughts and direct the course of the conversation. Parents avoided disclosure to select family members, based on five factors: geographical or emotional distance, age, and how conservative or religious family members were. While some relationships were strengthened with disclosure, many parents described tense or unsupportive relationships with extended family members, and some relationships dissolved. The findings suggest extended family members are both potential supporters and stressors, and parents engage in a variety of strategies to bolster their supportive networks while anticipating rejection and mitigating stress. These findings have implications for social work research, practice, and policy.

Transgender and Gender Nonconforming Youths’ Emotions: The Appraisal, Valence, Arousal Model

Increased scientific understanding explains why transgender and gender nonconforming (TGNC) youth report more mental health concerns than their cisgender peers. However, the emotional processes of TGNC youth have not been assessed beyond mental health diagnoses. Our aim in this study was to investigate how TGNC youth understand, experience, and label their emotional experiences. We conduced a two-tiered qualitative analysis of 20 predominantly White TGNC youths, ages 7–18 years, resulting in the creation of the appraisal, valence, arousal theory of emotions. Within the theory, emotions are categorized in four quadrants: Reflective/Unpleasant, Anticipatory/Unpleasant, Reflective/Pleasant, and Anticipatory/Pleasant. Results indicated that the majority of TGNC youths’ emotions were located in the Reflective/Unpleasant and Reflective/Pleasant quadrants. The current study highlights TGNC youths’ appraisal of emotions and the potential impact on youths’ cognitive and emotional processes. Interventions should attend to pleasant and unpleasant aspects of emotions while also focusing on youths’ understanding of the context of their emotions.

Social Predictors of Health Status Among Transgender and Gender Non-Conforming Youth

TITLE: SOCIAL PREDICTORS OF HEALTH STATUS AMONG TRANSGENDER AND GENDER NON-CONFORMING YOUTH PURPOSE: Transgender and gender non-conforming (TGNC) individuals experience significant health disparities compared to their cisgender counterparts. TGNC youth in particular may face distinct challenges when it comes to improving and maintaining health. There is limited research regarding TGNC youth and the mediating factors that may influence health status. The purpose of this study was to explore the association between various predictors, including gender identity, substance use, bullying, and …

How Are Transgender and Gender Nonconforming Youth Affected by the News? A Qualitative Study

PurposeNews stories about transgender and gender nonconforming (TGNC) people have become more common in recent years and TGNC youth may be disparately affected by this information compared with their cisgender peers. The aim of this study was to understand how TGNC youth react to news stories about TGNC and other gender and sexual minority (GSM) identifying persons. MethodsAs part of a larger study, 23 TGNC youth were recruited from the Seattle Children's Gender Clinic to participate in a semistructured interview. Interviews were audio recorded, transcribed, and thematically analyzed. ResultsParticipating youth ranged in age from 13 to 19 years (mean = 16.9 years). Of the 23 participants, 43% identified as having a transfeminine gender identity, 39% transmasculine, and 17% nonbinary/gender fluid. Four main themes were identified: (1) news coverage of current political climate affects gender transition; (2) negative news coverage of GSM people contributes to concerns about mental well-being and safety; (3) geographical location affects perception of news; and (4) positive news coverage of TGNC people increases visibility and hope. ConclusionsExposure to negative news about GSM people may contribute to increased levels of stress among TGNC youth. With increased visibility, participants described frustration associated with inaccurate portrayals of the TGNC community in the news; however, with increased visibility, there is also a growing sense of shared community and opportunity for acceptance of TGNC people. Given the scope of responses to negative and positive news on GSM people, TGNC youth may benefit from increased support to promote resilience when interpreting the news.

Diet and Physical Activity Behaviors Among Adolescent Transgender Students: School Survey Results

PurposeDiet and physical activity behaviors are determinants of health for adolescents; however, few studies have assessed these behaviors among transgender youth. This study examined dietary behaviors, physical activity, weight-based bullying, and weight status among four groups based on transgender and gender nonconforming (TGNC) status and birth-assigned sex. MethodsData were from a large cross-sectional, population-based, statewide survey of high school students (n = 80,794, Minnesota Student Survey, 2016). Comparisons were made for dietary and physical activity behaviors among TGNC and cisgender youth and among TGNC birth-assigned males and females and cisgender males and females. ResultsAbout 2.7% of the total survey respondents identified as TGNC. TGNC students were more likely to be ethnically diverse, not living with a biological parent, participating in free or reduced-price school meals, and skipping meals compared with cisgender students. TGNC youth reported less frequent intake of fruit and milk and more frequent intake of fast food and soft drinks than cisgender students. TGNC students were also more likely to be overweight or obese, bullied for weight or size, and less likely to be physically active compared with cisgender youth. TGNC birth-assigned males reported more frequent intake of fast food and soft drinks and less physical activity compared with TGNC birth-assigned females and cisgender boys and girls. ConclusionsTGNC students reported more negative health behaviors than cisgender students. Programs to address disparities in diet and physical activity behaviors may need to be tailored by gender identity and gender identity subgroups.

Social Connectedness Factors that Facilitate Use of Healthcare Services: Comparison of Transgender and Gender Nonconforming and Cisgender Adolescents

To compare social connectedness factors that facilitate use of primary, dental, and mental healthcare services among transgender and gender nonconforming (TGNC) and cisgender adolescents. Data from the cross-sectional 2016 Minnesota Student Survey were used to examine protective social connectedness factors associated with use of different healthcare services among matched samples of 1916 TGNC and 1916 cisgender youth. Stratified, logistic regression analyses were used to examine background characteristics and social connectedness factors (parent connectedness, connections to other nonparental adults, teacher-student relationships, and friend connections) associated with use of each healthcare service within the last year. For TGNC youth, but not for cisgender youth, higher levels of parent connectedness were associated with receipt of primary (OR, 2.26; 95% CI, 1.40-3.66) and dental (OR, 3.01; 95% CI, 1.78-5.08) care services, and lower levels of connectedness to nonparental adults was associated with receipt of mental healthcare (OR, 0.55; 95% CI, 0.33-0.93). Among cisgender youth, no protective factors were significantly associated with receipt of primary care services, higher levels of friend connections were associated with receipt of dental services (OR, 1.85; 95% CI, 1.10-3.09), and lower levels of parent connectedness were associated with receipt of mental healthcare (OR, 0.20; 95% CI, 0.10-0.40). To promote the health of TGNC youth, clinicians should understand the distinct factors associated with obtaining healthcare among this population such as the need for tailored efforts focused on strengthening connectedness between TGNC youth and their parents to facilitate receipt of needed care.