Transgender Youth Research Articles

Venous thromboembolism in transgender and gender non-binary youth is rare and occurs in the setting of secondary risk factors: A retrospective cohort study.

The risk of venous thromboembolism (VTE) with gender-affirming hormone therapy (GAHT) in transgender and gender non-binary (TNB) youth is unclear. To identify the rate of VTE in a cohort of TNB youth followed in the transgender health clinic at Boston Children's Hospital, and to investigate the impact of congenital thrombophilia diagnosis on the use of GAHT. ICD-9 and ICD-10 codes were used to identify eligible individuals, defined as (i) having a diagnosis of gender dysphoria and (ii) venous thromboembolism (VTE). Data were abstracted from a review of medical records. A second data query assessed TNB individuals who had an associated thrombophilia diagnosis. The primary analysis included 1860 individuals. Total 942 individuals (50.6%) had started GAHT at the time of data analysis. Mean age (±SD) at GAHT initiation was 16.8 (±1.9) years. Five thrombotic events were identified in three (0.13%) individuals, all in the setting of additional VTE risk factors. Only two of five thrombotic events occurred while receiving GAHT. The rate of VTE in the GAHT cohort did not statistically differ from the rate of VTE in the non-GAHT cohort (0.1% vs. 0.2%, p=.62). Of the 10 individuals diagnosed with a congenital thrombophilia, two transmasculine individuals received prophylactic anticoagulation prior to GAHT. No VTE has been reported to date in this cohort. In our cohort, VTE was rare in the TNB youth and was not associated with GAHT use. TNB youth with congenital thrombophilia have not developed VTE in the setting of GAHT use to date.

Parental perspectives on fertility preservation for their trans and gender-expansive children: Reflections on complexities of autonomy, support, and societal realities

Introduction Navigating fertility preservation poses unique challenges for young transgender and gender expansive (TGE) youths, who must balance short-term concerns like delaying gender-affirming hormonal treatment (GAHT) with long-term considerations of potential infertility. Parents play a crucial role in supporting their TGE children through their gender affirmation journey, which includes discussions about fertility preservation. Aim This study aimed to explore parental feelings and attitudes toward the fertility preservation of their TGE children, acknowledging the diverse perspectives shaped by societal, legal, and personal factors. Methods The study involved 82 parents who completed an online-distributed questionnaire. Participants were parents of TGE youths aged between six and twenty-five years old. The mixed-methods study utilized a tailored questionnaire comprising both open-ended and closed-ended questions. Results Descriptive analysis revealed that a significant majority of parents were aware of the effects of GAHT on fertility, with 65.3% expressing a desire for their children to have their own children in the future. However, parents shared that only 14.5% of children underwent a fertility preservation pathway, while 68.1% did not, citing barriers such as lack of services, cost, and procedural distress. Qualitative analysis identified four main themes: (1) Emotional response, (2) Parental expectations, (3) Parent-Child relationship, and (4) Structural barriers. Discussion Overall, the study underscores the multifaceted nature of parental experiences regarding fertility preservation for TGE individuals, emphasizing the importance of addressing societal norms, personal expectations, and structural barriers to ensure equitable access to reproductive healthcare services.

Losing, gaining, or staying the same: how do different weight change attempts relate to muscle dysmorphia and eating disorder symptoms across genders?

ABSTRACT Adolescents and young adults are at heightened risk for eating disorder (ED) and muscle dysmorphia (MD) symptoms; yet, these symptoms and their relationships to harmful behaviors may also vary by gender. Thus, this study examined: 1) the prevalence of attempts to lose, gain, or maintain the same weight across gender identities, 2) purposes of weight change attempts, and 3) relationships between weight change attempts and ED and MD symptoms across cisgender men, women, and transgender and gender expansive (TGE) youth. 940 adolescents and young adults (57.4% cisgender women, 33.8% cisgender men, 8.8% TGE) completed questionnaires about weight change attempts, ED and MD symptoms. Women and TGE individuals attempted to lose weight more often than men, while men attempted to gain weight more often. All genders endorsed weight loss and gain attempts for different purposes. Weight loss attempts related to ED symptoms and appearance intolerance, whereas weight gain attempts related to MD symptoms across genders. In women, all weight change attempts related to greater functional impairment due to exercise. Findings highlight the need for tailored interventions to address desires to change one’s body and underscore the harmful effects of weight change attempts across genders.

The Role of Sex and Gender in Transgender Bone and Other Musculoskeletal Health.

Musculoskeletal changes occur with gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS) used in the care of transgender adolescents and adults. Survey results have shown that orthopaedic surgeons desire to care for transgender individuals but express concern over a knowledge deficit. This article reviews the physiology and pathophysiology that may occur with GAHT and GAS. Transgender women have lower bone mineral density (BMD) prior to GAHT than cisgender men. Limited fracture data would suggest that transgender women >50 years of age have fracture rates similar to those of cisgender women. Transgender men have normal BMD prior to GAHT and are not at an increased risk for fracture compared with cisgender women. The use of puberty-blocking medications in the care of transgender youth does result in a decline in BMD, which returns to baseline with GAHT, but the effect of delaying puberty on maximal BMD and the lifetime fracture risk are unknown. At present, dual x-ray absorptiometry (DXA) is used to measure BMD and assess fracture risk. Attention should be paid to using the appropriate reference group in the interpretation of DXA for transgender individuals. Promote musculoskeletal health by ensuring appropriate calcium, vitamin D, weight-bearing activity, and a healthy lifestyle. Adherence to GAHT needs to be encouraged to avoid bone loss. Data with regard to therapy for osteoporosis in transgender patients have been lacking, but, at present, use of available therapies is expected to be effective. Information with regard to differences in other musculoskeletal health issues such as joint injuries has been lacking in transgender individuals.

Gender Identity and Its Influence on Social Support Networks among LGBTQ+ youth in New Zealand

Purpose: The aim of the study was to analyze the gender identity and its influence on social support networks among LGBTQ+ youth in New Zealand. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Research on gender identity and its influence on social support networks among LGBTQ+ youth in New Zealand highlights that individuals with diverse gender identities often face unique challenges in accessing and maintaining supportive relationships. Findings indicate that LGBTQ+ youth experience varying levels of support based on their gender identity, with those who identify as non-binary or transgender sometimes facing more barriers compared to their cisgender or gay/lesbian peers. Social support networks play a crucial role in providing emotional and practical assistance, but the quality and availability of these network Unique Contribution to Theory, Practice and Policy: Social identity theory, minority stress theory & ecological systems theory may be used to anchor future studies on gender identity and its influence on social support networks among LGBTQ+ youth in New Zealand. Implement educational programs for families to foster understanding, acceptance, and support for transgender and non-binary youth. Advocate for and implement comprehensive anti-bullying and inclusivity policies in schools that protect LGBTQ+ students. Policies should mandate the creation of safe spaces and support groups within educational institutions.

Body composition, metabolic syndrome, and lifestyle in treatment-naïve gender-diverse youth in Israel.

There is a scarcity of published studies evaluating transgender/gender-diverse youth before initiating gender-affirming hormones. To study the body composition, metabolic syndrome (MetS) components and lifestyle habits in treatment-naïve transgender youth. Cross-sectional study evaluating 153 transgender youth [median age 15.7 years, 94 transgender males] who attended The Israeli Children and Adolescents Gender Clinic between 6/2021-12/2022. Clinical, metabolic data and lifestyle habits (diet, physical activity and sleep patterns) were retrieved from the medical files. Body composition was determined by bioelectrical impedance analysis. Body mass index and muscle-to-fat ratio z-scores were calculated by sex designated at birth. Weight categories differed between genders, with a greater proportion of subjects classified as underweight among transgender females, and a greater proportion affected by overweight/obese/severe obese among transgender males (p = 0.035). The odds for MetS components were increased by 2.2 for every 1 standard deviation decrease in the muscle-to-fat ratio z-score (95%CI: 1.45 to 3.26, p < 0.001). About one-third of the cohort did not meet any of the three lifestyle recommendations. Transgender males had increased odds for MetS components by 3.49 (95%CI: 1.63 to 7.44, p = 0.001). Treatment-naïve transgender-male adolescents have an imbalance between muscle and adipose tissue, which places them at increased susceptibility for MetS components even prior to hormonal treatment.

Understanding Family Reactions to Transgender Children in Iranian Culture: A Qualitative Study.

The family plays a crucial role in shaping children's identity and understanding of gender-based roles. This study aims to explore the experiences of Iranian transgender individuals with their families' reactions to their transgender identity disclosure. In 2018, nurse researchers conducted this qualitative study on 11 transgender individuals in Iran using a phenomenological approach, targeted and snowball sampling, and Colaizzi's seven-step method for data analysis. Rigor was ensured by adhering to Lincoln and Guba's standards. The study found varied reactions to transgender children among Iranian families, including abuse to avoid stigma. The study revealed two main themes, maladaptive and adaptive reactions, and identified six categories: denial of reality, mourning, coercion, deprivation, support out of necessity, and compromise of family reactions. Education and support systems may help address the cultural challenges that face families with transgender children. The findings offer insights for enhancing public awareness of the transgender community in conservative cultures.

Unveiling the Pathways: Mapping and Understanding Hidden Homelessness Among 2SLGBTQ+ Youth in Ontario

Transphobic and homophobic violence and discrimination within homes and housing programs lead many 2-Spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) youth to find alternative, temporary, and insecure housing. These types of living situations are considered “hidden homelessness”. This study interviewed 2SLGBTQ+ youth (n = 6) and key informants (n = 12) who have experienced and/or who support hidden homelessness across three sites in Ontario (Toronto, York Region, and London). The results suggest experiences of hidden homelessness for 2SLGBTQ+ youth are nonlinear, with pathways driven by family conflict combined with the high cost of living and lack of employment, making independent living unaffordable. Additionally, youth avoid services where they experience discrimination and often experience social isolation. In rural and suburban areas, youth have fewer options for safe and inclusive services. When services are accessible, wrap-around supports that address the complexity of their situations help youth exit hidden homelessness. Prevention strategies should focus on addressing family conflict and supporting reunification when it is safe to do so. For those who are unable to return home, there is a need for increased financial support and more affordable housing. Building comprehensive population-based support services is recommended to address the overrepresentation of 2SLGBTQ+ youth experiencing homelessness.

“To smoke feels gender”: Exploring the transformative and emancipatory capacities of cannabis among transgender, non-binary and gender non-conforming (TGNC) youth

BackgroundTransgender, non-binary and gender non-conforming (herein, “TGNC”) youth (15–24 years old) face overlapping minority stressors (e.g., gender discrimination, lack of access to gender-affirming care, rejection, violence) that contribute to mental health inequities. TGNC youth also use substances at higher rates when compared to cisgender youth, including some of the highest rates of cannabis use in Canada. MethodsThis community-based participatory research study provides an in-depth qualitative, photovoice-based analysis examining how cannabis use features within the gender experiences of a sample of TGNC youth in British Columbia (BC). We conducted in-depth, semi-structured interviews with 27 TGNC youth (15–24 years old) from across British Columbia. Interviews were designed to elicit discussions about the photos youth had taken as well as various gender and mental health experiences related to their cannabis use. Analysis and identification of emergent themes was guided by social constructivist grounded theory as well as queer and trans theorizing and informed by community-based research approaches through regular meetings with our team's Substance Use Beyond the Binary Youth Action Committee comprised of TGNC youth who use substances. ResultsThree overarching themes pertaining to cannabis use and gender experiences amongst TGNC youth in our study were generated. First, participants used cannabis purposefully and strategically to enact diverse gender expressions and embodiments. Second, participants leveraged cannabis to support introspection whilst mobilizing identity discovery and development. Finally, participants mobilized cannabis as a vehicle for accessing moments of gender euphoria and affirmation. ConclusionsThese findings identify how some TGNC youth use cannabis to purposefully and strategically facilitate their mental health, well-being, identity development and self-expression. This research reveals critically important experiential and embodied dimensions of cannabis use that have not historically been considered in cannabis-related policy and the provision of care, including mental health and substance use-related care.

“My queer identity and my family identity are two very separate things”: A mixed-methods study investigating the psychological implications of family identity and support for trans and gender diverse youth during the COVID-19 pandemic.

“My queer identity and my family identity are two very separate things”: A mixed-methods study investigating the psychological implications of family identity and support for trans and gender diverse youth during the COVID-19 pandemic.

Substance use among trans and gender diverse young people in Australia: Patterns, correlates and motivations.

There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia. Using data from a national survey of Australian trans young people (N = 859, Mage = 19.4), we estimated prevalence of past 6-month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate-adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open-ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach. Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi-levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction. While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self-exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender-affirming care.

Childhood Gender Diversity and Mental Health: Protocol for the Longitudinal, Observational Gender Journey Project.

Prepubertal transgender, nonbinary, and gender-diverse (TGD) children (ie, those asserting gender identity, expressing gender-role behavior outside of culturally defined norms for their sex registered at birth, or both) are presenting in greater numbers to pediatric gender clinics across the United States and abroad. A large subset of TGD children experiences gender dysphoria, that is, distress that arises from the incongruence between gender identity and sex registered at birth. A lack of consensus exists regarding care for prepubertal TGD children due, in part, to a dearth of empirical research on longitudinal developmental trajectories of gender identity, role behavior, and gender dysphoria (when present). The objective of this National Institutes of Health-funded study is to provide evidence to inform clinical care for prepubertal TGD children by establishing a US longitudinal cohort (N=248) of prepubertal TGD children and their caregivers that is followed prospectively at 6-month intervals across 18 months. At each timepoint, clinical and behavioral data are collected via web-based visit from child and caregiver reporters. Latent class analysis, among other methods, is used to identify subgroups and longitudinally characterize the gender identity and gender-role behavior of TGD children. These models will define longitudinal patterns of gender identity stability and characterize the relationship between TGD classes and mental and behavioral health outcomes, including the moderating role of social gender transition (when present), on these associations. Baseline data collection (N=248) is complete, and the identification of TGD subgroups based on gender identity and expression using latent class analysis is anticipated in 2024. The completion of all 4 waves of data collection is anticipated in July 2024, coinciding with the start of a no-cost study extension period. We anticipate longitudinal analyses to be completed by winter 2024. Through a longitudinal observational design, this research involving prepubertal TGD children and their caregivers aims to provide empirical knowledge on gender development in a US sample of TGD children, their mental health symptomology and functioning over time, and how family initiated social gender transition may predict or alleviate mental health symptoms or diagnoses. The research findings have promise for clinicians and families aiming to ensure the best developmental outcome for these children as they develop into adolescents. DERR1-10.2196/55558.

Special Issue: Health Outcomes of Gender-Affirming Care Among Transgender and Gender Expansive Youth: Deadline for Manuscript Submission: September 17, 2024.

Special Issue: Health Outcomes of Gender-Affirming Care Among Transgender and Gender Expansive Youth: Deadline for Manuscript Submission: September 17, 2024.

Meaning-Making and Flourishing in a Challenging Society: Existential and Positive Psychology Approaches With Transgender Youth

Meaning-Making and Flourishing in a Challenging Society: Existential and Positive Psychology Approaches With Transgender Youth

Characteristics of Youth Presenting for Gender Care Compared to Background Populations: Examination of Social Determinants of Health.

Purpose: Transgender and gender diverse (TGD) youth in North American clinical reports are predominantly White with relatively high socioeconomic status suggesting that access to gender-affirming care is inequitable. This study examined whether socioeconomic and social determinant of health discrepancies exist between a clinical population of TGD youth and surrounding communities. Methods: Patient postal codes were used to link the Ontario Marginalization Index (ON-MARG) to a clinic-based TGD youth cohort (n = 298). Using ON-MARG, each patient was assigned a quintile score from 1 (least marginalized) to 5 (most marginalized) on four marginalization measures. Mean quintile scores were compared to background populations. Census-based Toronto neighborhood-level data on ethnic diversity and educational status were also examined. Neighborhoods were categorized as highly represented, less represented, or unrepresented based on representation in the clinic cohort. One-way analysis of covariance was used to determine associations between neighborhood-level variables and the degree of neighborhood representation. Results: ON-MARG data demonstrated that clinic patients hailed from areas with more individuals having paid employment. Patients from Toronto and surrounding areas came, in general, from communities with fewer recent immigrants and visible minorities. Highly represented Toronto neighborhoods had smaller proportions of visible minorities and immigrants compared with less and unrepresented neighborhoods. Educational status, represented by adults with bachelor's degrees, was lower among unrepresented neighborhoods. Conclusion: TGD youth seen in clinic, particularly those from Toronto, are disproportionally White and socioeconomically advantaged. Further research is needed to better understand the underrepresentation of racialized and low-socioeconomic status youth and to inform strategies to improve access to care.

Bystanders to Sexual Violence: Findings From a National Sample of Sexual and Gender Diverse Adolescents.

Mobilizing bystanders to prevent sexual violence is an increasingly popular prevention strategy. While research has identified characteristics related to opportunity and actions around helping, a more nuanced understanding of how helping behavior and its modifiable levers may differ for youth of various genders is needed. The current study examined bystander-helping behaviors in sexual violence situations in a national, social media-recruited sample of adolescents 14 to 16 years of age. Measures of opportunity and self-reported actions were included in an online survey along with items assessing attitudes related to violence and helping. Given that prevention programs may work differently for cisgender, transgender, and nonbinary young people, between-group differences in amount of opportunity and helping behaviors were examined. Further, we examined correlates of opportunities to help as well as helping behaviors within each group. Overall, few attitude and personal experience characteristics consistently predicted opportunities and behaviors across groups. Group differences that emerged, such as the association between attitudes supportive of rape and lower helping for cisgender but not trans or nonbinary youth, support attending to these group differences in both basic and intervention research to inform tailoring of prevention programs.

Intersectional Social Support: Gender, Race, and LGBTQ Youth Friendships

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience disproportionate mental health challenges due to minority stress. Little research, however, has considered how social support from intragenerational friends impacts the mental health of LGBTQ youth, particularly for LGBTQ youth of color. Based mainly on qualitative interviews from a longitudinal study with 83 LGBTQ youth from California and Texas, we develop the concept of intersectional social support—how multiply marginalized individuals subjectively interpret social support and how they view social support from similar multiply marginalized others. More specifically, the findings of this study capture how the intersecting identities of age, sexuality, gender, and race can shape the meanings and experiences of receiving familial support, emotional support, informational support, and instrumental support. This study is an important contribution to understanding how intersecting identities influence how people perceive social support practices and manage their mental health.

Gender-Sexuality Alliance Experiences and LGBTQ+ Inclusive School Policies and Practices Predict Youth's School Belonging.

Gender-Sexuality Alliances (GSAs) and inclusive school policies and practices that affirm youth with minoritized sexual orientations or gender identities (e.g., lesbian, gay, bisexual, transgender, queer youth; LGBTQ+ youth) are two sources of support for LGBTQ+ youth that could promote school belonging. The current study tested a three-level multilevel model in which youth's GSA experiences and the degree to which their schools implemented LGBTQ+ inclusive policies and practices predicted their school belonging over a six-month period. Participants included 627 youth (87% LGBQ+ youth, 45% transgender or nonbinary youth, 48% youth of color) ages 11-22 (Mage = 15.13) in 51 GSAs. At the within-individual level, youth reported greater school belonging on occasions following months when they felt their peers and advisors were more responsive to their needs and when they had taken on more leadership in the GSA. At the between-individual level, youth who generally felt their peers were more responsive over the study period reported greater school belonging than others. At the between-GSA level, GSA members in schools that more thoroughly implemented LGBTQ+ inclusive policies and practices reported greater school belonging over the study period. These findings underscore the relevance of GSAs and inclusive policies and practices in establishing welcoming school environments.

Moving Beyond Statements to Protect Transgender Youth

This Viewpoint explores the politicized nature of gender-affirming care for transgender and nonbinary youth and how children’s hospitals can provide education, resources, and access to families seeking care.

Transgender Solidarity and Gender Out of Place

In recent years, conservative attempts to erase gender diversity—directed at transgender youth in particular—have taken on new momentum. Schools are restricted from respecting students’ identities, libraries are being censored, and families are being prevented from seeking gender affirming counseling. At the same time, it is also clear that transgender, nonbinary, and other gender creative youth are increasingly demanding respect. Education about and through gender is being prevented and sometimes criminalized precisely when all students and educators need to be considering gender in more depth, breadth, and intersectional complexity. The transgender rights movement has been attentive to forms of gender diversity that draw more people into solidarity. This paper suggests following that strategy of building connections among genders while also understanding different forms of gender have different needs, structural positions, and histories, too. Understanding how to balance both a complex analysis of gender and a firm commitment to act in solidarity of gender diversities can help us to teach about and through gender, as well as resist how gender diversities are literally being pushed out of place in many states.