Transgender Youth Research Articles

Estradiol increases cortical and trabecular bone accrual and bone strength in an adolescent male-to-female mouse model of gender-affirming hormone therapy

The effects of gender-affirming hormone therapy on the skeletal integrity and fracture risk in transitioning adolescent trans girls are unknown. To address this knowledge gap, we developed a mouse model to simulate male-to-female transition in human adolescents in whom puberty is first arrested by using gonadotrophin-releasing hormone analogs with subsequent estradiol treatment. Puberty was suppressed by orchidectomy in male mice at 5 weeks of age. At 3 weeks post-surgery, male-to-female mice were treated with a high dose of estradiol (~0.85 mg) by intraperitoneal silastic implantation for 12 weeks. Controls included intact and orchidectomized males at 3 weeks post-surgery, vehicle-treated intact males, intact females and orchidectomized males at 12 weeks post-treatment. Compared to male controls, orchidectomized males exhibited decreased peak bone mass accrual and a decreased maximal force the bone could withstand prior to fracture. Estradiol treatment in orchidectomized male-to-female mice compared to mice in all control groups was associated with an increased cortical thickness in the mid-diaphysis, while the periosteal circumference increased to a level that was intermediate between intact male and female controls, resulting in increased maximal force and stiffness. In trabecular bone, estradiol treatment increased newly formed trabeculae arising from the growth plate as well as mineralizing surface/bone surface and bone formation rate, consistent with the anabolic action of estradiol on osteoblast proliferation. These data support the concept that skeletal integrity can be preserved and that long-term fractures may be prevented in trans girls treated with GnRHa and a sufficiently high dose of GAHT. Further study is needed to identify an optimal dose of estradiol that protects the bone without adverse side effects.

Doing it together, but in a queer way: joyful worldmaking with 2SLGBTQI + folks in Atlantic Canada

This paper explores the joyful worldmaking that circulated between a group of 35 queer and trans adults and youth from across Atlantic Canada—New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador—who came together in February 2023 for a do-it-yourself (DIY) archiving and artmaking workshop on unceded and unsurrendered Wolastoqiyik territory in Fredericton, New Brunswick—as part of an ongoing participatory visual research initiative called Pride/Swell+. Exploring this worldmaking through frameworks of queer joy, we ask: How does worldmaking circulate within the Pride/Swell + workshop space and archives? Why is queer and trans worldmaking valuable to 2SLGBTQI + youth? What is the importance in remembering and archiving the things that queer and trans folks are doing to craft their everyday lives? Through DIY artmaking and participatory methodologies, we explore how Pride/Swell + fosters spaces for 2SLGBTQI + folks, including youth, to think about their lives and queer communities in celebratory and joyful ways. Ultimately, we argue that uplifting everyday moments of queer and trans worlds in our project promotes a more complicated and nuanced understanding of what it means to be 2SLGBTQI + in Atlantic Canada.

Experiences of cisgender youth with a transgender and/or nonbinary sibling.

While recent research has begun to address the effects of family support on transgender and/or nonbinary youth (TNY), almost no studies have directly examined how cisgender siblings in families with TNY navigate their sibling's gender disclosure and affirmation within both their families and their larger communities. We conducted an exploratory secondary analysis of in-person, semi-structured interviews with 15 adolescent and young adult siblings (age 13-24 years) of TNY from the northeastern United States from the baseline wave of the community-based, longitudinal, mixed methods Trans Teen and Family Narratives Project. Interview transcripts were analyzed using immersion/crystallization and template organizing approaches. Analyses yielded three main themes: gender-related beliefs and knowledge, peri- and post-disclosure family dynamics, and assessing responses to their sibling. Subthemes included anticipation of their sibling's TN identity, expectations post-disclosure, participants' level of involvement in gender-related family processes, perceptions of changes in family relationships, concern for their sibling (including a high degree of attunement to gender-affirming name and pronoun usage), and concern for themselves. Findings from this study suggest the need to engage directly with siblings of TNY to further elucidate their intrapersonal, intra-familial, and extra-familial experiences related to having a TN sibling and determine their unique support needs. Implications for families, clinicians, and communities are discussed.

"Transgender children" are being discussed in the UK!

Prof. Nevzat Tarhan who translated and edited the book that questioned the basis of the anti-gender theses stated that: "The building block of society is the family. It is a social responsibility to say no to a view that reduces marriage to sexuality rather than companionship..."

Protect Trans Kids: A Call to Action

The last several years have seen an increasing number of attacks on marginalized groups in the United States, including people of color, women, and members of the LGBTQ+ community. Most recently, some state legislatures have focused their efforts on preventing transgender youth from accessing gender-affirming medical care. Despite a virtually unanimous consensus on the importance and benefits of gender-affirming care, many conservative politicians have taken aim at vulnerable children, standing in the way of potentially life-saving treatment and accusing their families and doctors of child abuse. Laws preventing transgender youth from receiving gender-affirming care are just one battle in the larger war on individual liberty interests, bodily autonomy, and health care privacy. Already, anti-trans laws written under the pretext of protecting minors are being expanded to detransition transgender adults and criminalize the very existence of transgender people. At the same time, pregnant people around the country are losing their reproductive rights and access to safe and legal abortions. These are both part of a concerted effort to wedge the unjust influence of oppressive state governments into two of the most intimate social and legal relationships: the relationship between a child and their parent, and the relationship between a patient and their doctor. This Comment argues that these attacks must be met by political resistance. Litigation before the current Supreme Court and its conservative majority may do more harm than good, and patients in need of medical care deserve prospective protections to safeguard their right to privacy. Therefore, comprehensive federal legislation, such as the proposed Equality Act, is the best solution to protect transgender youth and the broader right to privacy in health care.

Access to healthcare among transgender and non-binary youth in Sweden and Spain: A qualitative analysis and comparison.

Transgender and non-binary (TGNB) people tend to report worse health than cis people, however, despite an increased need for care, they face several barriers when trying to access healthcare. These barriers might be exacerbated when young age intersects with a trans identity, and so there is a need for studies highlighting the experiences of TGNB youth. To explore and compare how TGNB youth (15-26 years old) in Sweden and Spain experienced their access to healthcare, in order to shed light on the strengths and limitations of different kinds of healthcare systems and improve healthcare provision and policy development. This study was based on a qualitative analysis of semi-structured interviews with TGNB youth living in Sweden (n = 16) and Spain (n = 18). Of these, 22 identified as male or transmasculine, six as non-binary, and six as women or transfeminine; 25 had undergone some type of gender-affirming care, and the rest were on the waiting list or undergoing preparatory visits and had not started hormonal treatment. The interviews were analyzed using reflexive thematic analysis. An abductive approach was applied, and the Levesque conceptual framework was used to compare the analyses of each set of materials. We present our findings using the structure of the accessibility framework, focusing on approachability, acceptability, availability, affordability, and appropriateness. The conceptualization of accessibility in combination with the concept of cisnormativity illustrates how specific ideals and normative expectations affect access to healthcare for TGNB people across contexts, with most barriers arising from the appropriateness of the services. Young TGNB people experience barriers to accessing healthcare both in the Spanish and the Swedish contexts. Strategies to reduce these barriers should be framed within the critique of and resistance to cisnormativity and should focus on users with intersecting marginalized identities to promote health equity.

Unaccompanied unstable housing among racially, ethnically, sexually, and gender diverse youth: Intersecting identities bearing the greatest burden.

Disparities in youth homelessness by racial/ethnic, sexual, and gender identities are well documented, though this literature lacks specificity regarding intersectional social identities of youth who are most likely to experience homelessness. Population-based cross-sectional data on youth from the 2019 Minnesota Student Survey (N = 80,456) were used to examine the relationship between parent caring and intersections of minoritized identities that experience the highest prevalence of two distinct types of unaccompanied unstable housing with expanded categories of sexual and gender identities. Exhaustive chi-square automatic interaction detection models revealed that low parent caring was the most common predictor of unaccompanied homelessness and running away, but there was important variation among youth of color at the intersection of sexual and gender identities. The findings reveal a more complex story of disparities in unaccompanied unstable housing among youth with multiple marginalized social identities and highlight the need to create culturally informed prevention and intervention strategies for parents of LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and questioning) youth of color. The implications for prevention and intervention among subgroups with the highest prevalence are discussed in the context of interlocking systems of power and oppression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Demographic and mental health profile of youth in a gender service: An African case series.

Despite a massive global increase in research on gender-diverse youth, there have been no studies in Africa on gender-diverse children and adolescents presenting to health services. This study aimed to present the first African findings of the demographic and mental health profile of youth who have presented at a gender service in South Africa. A specialist mental health outpatient service, consisting of psychiatry, psychology and nursing input, for gender-diverse child and adolescent patients in the Western Cape. All consenting youth seen at a gender service, consisting of psychiatry, psychology and nursing input, in state and by the same clinician in private practice between January 2012 and May 2019 were participants of a retrospective, sequential case series study. Data of interest, including gender identity and sexuality, mental health history and social information, were extracted from the psychiatry files of participants. Thirty-nine participants were part of the registry and qualified for the study: 72% self-identified as white, 15% as coloured and 13% as black African. The rate of co-occurring psychopathology was high (64%) and included high rates of autism, particularly in trans males (26%), suicidal ideation in 31% and a history of suicide attempt(s) in 10%. This first study describing gender-diverse youth seeking support relating to their gender identity in Africa showed they had remarkable similarities to those studied internationally. Establishing that transgender youth of all major racial groups in the province with similar demographic profiles to other parts of the world are presenting to services in South Africa and in need of mental health support and interventions.

Effects of Puberty Blocker Treatment on Voluntary Wheel Running Activity in Young Rats

Background: Barriers to physical activity in transgender youth often center on social and psychological factors, but the effects of puberty blocking treatment that some youth receive on physical activity have yet to be explored. This study investigated the effects of puberty blocking treatment on physical activity in young female and male rats. Methods: Four week old female (F, n=19) and male rats (M, n=19) received the gonadotropin releasing hormone agonist (GnRHa) triptorelin as a puberty blocker (F-PB, n=10; M-PB, n=10) or saline as a control (F-CON, n=9; M-CON, n=9) for 4 weeks. Animals were then housed in voluntary wheel running (VWR) cages and activity was recorded during treatment period. Results: Main drug (p<0.0001) and sex (p=0.045) effects with a significant drug x sex interaction (p=0.0095) was observed with total 4 week running distance with F-PB having a lower VWR activity than F-CON (240 ± 23 km vs 67 ± 9 km, respectively, p<0.0001) and M-PB having lower VWR activity than M-CON (165 ± 15 km vs. 77 ± 14 km, respectively, p<0.001). Significant differences in daily wheel running distance were first detected on day 5 for F-PB when compared to F-CON (p=0.036) and on day 11 for M-PB when compared to M-CON (p=0.034). Conclusions: Treatment with a GnRHa reduced voluntary running wheel activity in young female and male rats. Social and psychological factors are important variables impacting physical activity in transgender youth, but puberty blocker treatment may be an additional factor to consider when addressing physical activity.

“Something that is so overlooked”: joyfully exploring queer bodies and sexualities in sexuality education with teachers in New Brunswick, Canada

ABSTRACT In this paper, we seek out the possibility of joyful and queered spaces of sexuality education. The sexual lives of queer and transgender youth are often passed over in sex and sexuality education classrooms. In this study, we were interested in exploring how sexual and bodily diversity make an appearance in these often-normative spaces. Through participatory visual research methodologies, we created art and media alongside 40 teachers in the province of New Brunswick, Canada, to look at the ways in which queer sexualities and bodies are made possible and impossible in their sex education practice. In three workshops, we found teachers negotiating the presence of 2SLGBTQI+ sexuality in their classrooms and a missing discourse of queer pleasure – mimicking the province’s tired sexuality education curriculum. We notice that artmaking helps diffuse the discomfort that often accompanies talking (and teaching) about sex in workshop spaces. We argue that sexuality educators need additional professional learning and resources to tend to the sexual lives of young people – and ultimately, a queering of sexuality education that is more intersectional, pleasure-centred, and joyful.

Agents of scientific uncertainty: Conflicts over evidence and expertise in gender-affirming care bans for minors

Globally, as medical and mental health associations increasingly have expressed support for the gender-affirming care model for trans and gender expansive youth, this model has been paradoxically banned across the United States. Ban proponents have deemed the science behind gender-affirming care to be dangerously uncertain. Examining the first gender-affirming care ban for minors, Arkansas's Save Adolescents from Experimentation (SAFE) Act of 2021, we addressed the following two questions: 1) who are the scientists, clinicians, and political organizations that promote SAFE and similar bans?; and 2) what are the scientific arguments they make to defend SAFE in federal court? First, we developed a typology of the various “agents of scientific uncertainty” behind these bans, drawing on literature from the sociology and history of science and medicine as well as the political economy of scientific doubt. Second, we created and qualitatively analyzed a dataset featuring 375 unique citations referenced throughout federal litigation over SAFE to identify these agents of scientific uncertainty's arguments. We sorted these arguments into eight categories, which reveal how agents distorted scientific evidence and exaggerated real uncertainties and risks in gender-affirming care. This case study establishes a frame for understanding the growing prevalence and legal impact of scientific arguments against gender-affirming care.

Cognitive and Developmental Profiles Associated with Self-Reported Sexual and Gender Minority Stigmatization Among Binary Transgender Adolescents

ABSTRACT Objective Sexual and gender minority (SGM) stigmatization is a key factor related to transgender adolescent mental health. While previous research has focused on direct associations between stigmatization and mental health, the present study of transgender youth, equitably recruited across the autism spectrum, examines cognitive and developmental factors in relation to the self-report of experienced and perceived SGM stigmatization. Method 65 binary transgender adolescents (43% transfeminine; ages 13–21 years) were intentionally recruited across the spectrum of autism traits from no traits to full criteria autism. Participants completed measures of autism-related social differences, cognitive abilities, and self-reported directly experienced and perceived SGM stigma. Autism-related social differences, cognitive abilities, and age were studied in relation to both SGM stigma factors. Results Autism-related social differences were negatively associated with level of directly experienced SGM stigma but unassociated with perceived stigma. Greater cognitive ability was positively associated with level of perceived SGM stigma, but unassociated with report of directly experienced stigma. Older age was positively associated with level of perceived SGM stigma. There was a statistical trend toward older age positively associated with level of directly experienced stigma. Conclusions The present study identifies candidate cognitive and developmental influences on self-reported SGM stigmatization among transgender adolescents, evenly recruited across the autism spectrum. The factors which may impact the perception and experience of stigmatization have been notably under-explored in the mental health field. The examination of these individual characteristics may allow for more precise predictive models for research with transgender youth, and ultimately, in clinical care.

“I feel like I’m living the authenticity of my being”: gender identity developmental trajectories of trans youth in Portugal

Background Research into the identity development of trans people has been emerging, but there is still a need for further study. While significant processes for identity construction take place during late adolescence and early adulthood, it is important to understand which milestones are associated with the trajectories of gender identity (GI) development. Aims The present study aimed at exploring the gender identity (GI) developmental trajectories of young Portuguese trans people and the processes associated with them. Methods Interviews were conducted with sixteen young people aged between 16 and 26, recruited through LGBTI+ formal associations and informal online groups, as well as through psychology and sexology consultations. The interviews were conducted face-to-face and online and were analyzed through thematic analysis, which aims to identify, analyze and report patterns in a qualitative data series. Results Six themes were identified and linked to developmental milestones. These were related to: (1) Discomfort in relation to the gender assigned at birth and its social roles; (2) Body discomfort; (3) Discovery of trans identities; (4) Disclosure of GI; (5) Perceived support; (6) Authentic living of GI. Linked to these themes, four sub-themes were identified as well. Discussion Based on the life course theory, moments of transition and turning points were identified, as well as social influences such as historical time and place. Thereby, this study contributed to a better understanding of trans youth’s GI developmental trajectories in the Portuguese context, where the study on this topic is still emergent, also contributing to inform the path to be taken at the international level regarding socio-legal policies concerning trans youth.

Transgender and gender diverse youths' experiences of healthcare: A systematic review of qualitative studies.

Transgender and gender-diverse (TGD) populations are identified as high-risk for negative healthcare outcomes. Limited data exists on experiences of TGD youths in healthcare. The review aim is to systematically review literature on healthcare experiences of TGD youths. Seven electronic databases were systematically searched for relevant studies. Pre-determined eligibility criteria were used for inclusion with a double-screening approach. Sixteen studies were included. Studies included were quality appraised, data were extracted, and findings were synthesized narratively. Four narratives were identified including experiences of: accessing care, healthcare settings and services, healthcare providers, and healthcare interventions. Long waiting times, lack of competent providers, and fear were reported as challenges to accessing gender-affirming care. Negative experiences occurred in mental health services and primary care, while school counseling and gender clinics were affirming. Puberty blockers and hormone-replacement therapy were identified as protective factors. TGD youths are at risk of negative health outcomes due to an under resourced healthcare system. Further research is needed to assess interventions implemented to improve TGD youth's experiences.

Time Course of Body Composition Changes in Transgender Adolescents During Puberty Suppression and Sex Hormone Treatment.

Transgender adolescents can undergo puberty suppression (PS) and subsequent gender-affirming hormone therapy (GAHT) but little information is available on the expected rate of physical changes. To investigate the time course of body composition changes during PS and GAHT. In this study, retrospective data of 380 trans boys and 168 trans girls treated with PS prior to GAHT from a gender identity clinic were included. Total lean and fat mass Z-scores using birth-assigned sex as reference were determined using dual-energy X-ray absorptiometry. In trans boys, lean mass Z-scores decreased (-0.32, 95% CI -0.41; -0.23) and fat mass Z-scores increased (0.31, 95% CI 0.21; 0.41) in the first year of PS and remained stable thereafter. Lean mass Z-scores increased (0.92, 95% CI 0.81; 1.04) and fat mass Z-scores decreased (-0.43, 95% CI -0.57; -0.29) only during the first year of testosterone,. In trans girls, both lean and fat mass Z-scores gradually changed over 3 years of PS (respectively -1.13, 95% CI -1.29; -0.98 and 1.06, 95% CI 0.90; 1.23). In the first year of GAHT, lean mass Z-scores decreased (-0.19, 95% CI -0.36; -0.03) while fat mass Z-scores remained unchanged after 3 years (-0.02, 95% CI -0.20; 0.16). Compared with peers, trans girls experienced ongoing lean mass decrease and fat mass increase during 3 years of PS while in trans boys smaller changes were observed that stabilized after 1 year. A large increase in lean mass Z-scores occurred only during the first year of testosterone treatment. In trans girls, body composition changed only slightly during GAHT. This information can improve counseling about treatment effects.

Longitudinal Family Functioning and Mental Health in Transgender and Nonbinary Youth and Their Families.

This study examined concordance of family members' perspectives of family functioning and mental health across two years in families with transgender and/or nonbinary youth (TNBY). Participants were 89 family members (30 TNBY, age 13-17 years; 44 cisgender caregivers; 15 cisgender siblings, age 14-24 years) from 30 families from the U.S. New England region. Family members completed an online survey every 6-8 months for 5 waves between December 2015 and Feb 2019. Surveys assessed family functioning (quality of communication, satisfaction with family) and the following mental health-related outcomes: depression and anxiety symptoms, non-suicidal self-injury, suicidality, self-esteem, and resilience. Analyses tested concordance of family functioning and mental health across family members. Reports of family functioning changed over time, and family members were not consistently concordant in their reports of family functioning. Caregivers perceived a higher quality family communication than TNBY at all waves and higher than siblings at some waves. Perceptions of family satisfaction did not show a clear pattern between family member types across waves. The greatest concordance of perceived family functioning was between caregivers and siblings and between TNBY and siblings. Across all waves, TNBY reported more severe depression and anxiety symptoms than their caregivers and siblings, and more non-suicidal self-injury than their siblings. Compared to siblings, TNBY reported higher self-esteem, but less resilience. This study highlights opportunities for intervention in clinical work with TNBY and their families. Providers working with families with TNBY should use family systems approaches to support the mental health of all family members.

Mental health of transgender children and adolescents: a systematic review

Introduction: Studies on the mental health of transgender children and adolescents express high rates of depression, anxiety, and suicide. It is important to highlight that this is probably due to the minority stress with which these individuals deal since the infrastructures and social policies are designed to treat and welcome cisgenders, based on a normative character. This configuration is associated with a long and past history, of continuous prejudice, stigmatization, and discrimination, conflicts between appearance and gender identity, and rejection in social and family environments. All of these factors contribute decisively to the serious psychiatric morbidity perceived in this population. Objective: The present article aims to identify the relevant aspects of the mental health of transgender children and adolescents and explore other factors associated with the reduction of psychopathological disorders in this population. Methods: A systematic review of the scientific literature was conducted in the PubMed and Virtual Health Library indexed databases, using the descriptors "mental health", "transgender persons" and "children" with the Boolean operator AND. Studies discussing the subject, published between 2010 and 2020 in all available languages, were included, and those that did not meet the criteria were excluded. The survey and screening were carried out in parallel by three researchers, disclosing in the selection of 56 articles. Results: The studies indicated a higher frequency of psychological disorders like depression, anxiety, ideation and suicide, self-harm, low self-esteem, substance abuse, and other risk behaviors in the studied population when compared to the rest of the population. The studies also presented other aspects related to the mental health, such as the importance of family support, social transition, and institutional, medical, and psychological support. Conclusion: The evidence presents the challenges faced by this population in their needs and assured rights, culminating in the developing or worsening of psychological disorders.

Parenting the Phoenix

For many parents of transgender or non-binary children the experience is transformative learning (Mezirow, 1978). This life history study of 17 parents of children aged 6 to 29 comprised of 33 interviews, 10 participant journals, and an autoethnography. Findings from the data indicated parental learning was a holistic experience (Illeris, 2003), a balance of emotion, cognition, and sociality. When one domain of learning was overstimulated, learning could be disrupted. Parents restructured their conceptions of gender, working through understandings of gender from their past and new ideas of the present. Learning also occurred in two phases, a private phase of cognitive reframing and then a more public phase as parents learned to advocate for their child. Most parents were anchored by value of authenticity, and some mothers revisited the notion of “What makes a woman?” For some, working through discomfort was one part of the learning process.

How education research perceives queer Asian American youths: a literature review

Academia has long neglected lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, and nonbinary (LGBTQIA+, queer) Asian American youth. Indeed, most available literature that examines queer Asian American issues falls victim to the matrix of domination. Succumbing to this matrix effectively amplifies the voices that are the least stratified within a broader social group (i.e. cisgender, gay, white men within the queer community). This literature review examines works between 1998-2023 to deliberately expand the existing lexicon for queer Asian American youth and hopes to catalyze future scholarly efforts in this area.

Association of Pubertal Blockade at Tanner 2/3 With Psychosocial Benefits in Transgender and Gender Diverse Youth at Hormone Readiness Assessment

PurposeCompare psychosocial function at the time of hormone readiness assessment for transgender and gender diverse (TGD) youth who received pubertal blockade to prevent a nonaffirming puberty with those who did not. MethodsRetrospective cohort study of psychological assessment data from hormone readiness evaluations conducted at a multispecialty gender clinic. Participants include all TGD youth between the ages of 13 and 17 assessed for hormone readiness between 2017 and 2021. ResultsOur cohort consisted of 438 TGD youth, 40 who were prescribed pubertal blockade at Tanner stage 2 or 3, and 398 who had not. The blocker population was younger, more likely to be assigned male and affirming a female identity, and had a different racial/ethnic identity distribution. Having puberty blocked was associated with significantly lower T-scores on the Youth Self Report for internalizing problems (β = −7.4, p < .001), anxiety problems (β = −4.6, p = .003), depressive problems (β = −6.5, p < .001), stress problems (β = −4.0, p = .01), and total problems (β = −4.9, p = .003). The blocker population was also significantly less likely to report any suicidal thoughts (odds ratio = 0.38, p = .05). With the exception of increased risk of suicidal thoughts, these associations remained significant when adjusted for gender. DiscussionAt the time of hormone readiness evaluation, TGD youth who received pubertal blockade at Tanner 2 or 3 were found to have less anxiety, depression, stress, total problems, internalizing difficulties, and suicidal ideation than TGD peers who had been through more of a nonaffirming puberty.