Transgender Youth Research Articles

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

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

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

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

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

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

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

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

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

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

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

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

Major MH disparities found among trans vs. cis youth

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

A thematic analysis of the experiences of prepubertal transgender and gender-diverse children in Sweden

Knowledge of prepubertal transgender and gender diverse (TGD) children is limited. This study fills a gap in the research literature by exploring the lived experiences of prepubertal TGD children related to gender identity, centering their voices. Interviews with 10 TGD Swedish children 4–12 years old were analyzed through Thematic Analysis. The analysis resulted in two main themes: (1) “The journey of gender exploration,” with subthemes Discovering me and The joys, and challenges of being me; (2) “Meeting the outside world,” with subthemes Can I belong? and Staying me: my tips, tricks and help from others. The children’s evolving gender identity was traced, emphasizing emotional aspects and pivotal milestones like affirmed names. Even though the children had supportive environments, challenges of misgendering and the need for continual self-assertion were exposed. Despite struggles for recognition, the study highlights TGD children’s resilient coping and well-being. Still, cisgender norms were observed to challenge their prevalent pride and positive self-images, emphasizing the need for enhanced knowledge of gender diversity for a broader societal change. This study expands the literature on TGD children’s gender identity development, informs professionals and a broad audience and provides an enhanced understanding of TGD prepubertal children through their own words.

Trans Tricksters, Looping Effects, and Gender Diagnoses as Containment

This essay examines how medical rhetorics helped justify the recent torrent of anti-trans legislation. Beginning with the “legitimacy wars” between psychiatry and psychology, I trace how competing disciplines established their own expertise by denying trans patients’ agency and self-knowledge. After identifying the “trans trickster” trope that emerges from these rhetorics, I trace how the trans trickster haunts arguments used to ban gender-affirming health care and sports participation for trans youth. I draw from sociologist Ian Hacking’s “looping effects” to explain how medical logics affect public perception and how those understandings loop back into medical research. The binary, linear models of gender transition established by trans medicine helped justify cisnormative policies around transgender identity, which in turn restricted further scientific inquiry such that more imaginative gender formations remain illegible. To conclude, I argue that medical paradigms work in relation with trans imagination would expand scientific explorations of human diversity, and that those understandings too could loop through public policy and perception.

Qualitative Metasummary: Transgender and Gender Diverse Children’s Experiences of Parental Responses

This qualitative metasummary literature review study explores transgender and gender diverse (TGD) children’s experiences of parents responding to their gender identities. In data collection for this study, we identified 31 peer-reviewed articles addressing this research topic. Studies included qualitative data collected from TGD children. Data analysis yielded three themes, six subthemes, and 35 findings. The primary three themes highlight TGD children’s experiences of supportive, unsupportive, and intermediate parental responses to their gender identities. In this paper, we provide examples of study findings and implications that healthcare providers may consider when offering gender-affirming care to TGD children with accompanying parents.

Growth and Adult Height Attainment in Danish Transgender Adolescents Treated with GnRH Analog and Sex Hormones

Abstract Background Endogenous sex steroids influence the pubertal growth spurt and adult height. However, the impact of puberty suppression and sex steroids on growth in transgender adolescents is sparsely studied. Aim We investigated pubertal growth, serum IGF-I and IGFBP-3, and adult height of transgender adolescents receiving hormone therapy. Methods Observational study of a national cohort (2016-2023) comprising 219 transgender adolescents <18 years of age. Treatment consisted of gonadotropin-releasing hormone agonist (GnRHa) combined with estradiol or testosterone (adjusted to serum concentrations between 0 and +2 standard deviations (SDs) corresponding to the gender identity). Results Adult height was within ±2 SD for sex assigned at birth. Most trans girls reached adult height within references of girls. For trans girls (bone age ≤15 years before treatment), a growth spurt was observed during estradiol therapy. IGF-I and height SDS declined during oral estradiol administration (-0.13 SDS per month, p=0.059, and -0.02 SDS, p=0.001, respectively). We observed significantly lower adult height compared to target height for trans girls (-2.7 cm, p=0.01), and significant differences between height SDS before treatment and at adult height (-0.35 SDS, p<0.001). Half of the trans boys remained short (<-2 SD) compared to references for boys, and most completed growth spurt before initiation of treatment. IGFBP-3 declined following testosterone treatment. There was a significant difference between height SDS before treatment and at adult height (-0.17 SDS, p<0.001). Discussion and Conclusion The minor reduction in adult height of trans girls after hormone treatment may be beneficial to some, whereas trans boys did not experience height gain.

"I wouldn't have felt so alone": The sexual health education experiences of transgender and gender diverse youth living in the southeastern United States.

Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. We conducted a multi-stage thematic analysis of 33 in-depth interviews among transgender and gender diverse youth (ages 15-24) living in the southeastern United States on their sexual health education experiences. Our study participants described school-based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white-centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment-free information while holding positive framing around sexuality and gender. There is much work needed to improve the breadth, quality, and relevance of school-based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community-based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer-friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways.

Reproductive Health in Trans and Gender Diverse Patients: Fertility related knowledge, attitudes, and decision-making among gender diverse youth - A narrative review.

Transgender and gender diverse (TGD) youth demonstrate low utilization of fertility preservation before medical and surgical gender-affirming interventions. However, a significant number of TGD youth have goals for parenthood and/or recognize that their attitude toward future family-building goals may change over time. In this narrative review, we conclude that TGD young people should have ongoing opportunities to discuss their family-building goals and options for fertility preservation. Validated decision tools can help facilitate these discussions. The number of transgender and gender diverse (TGD) youth seeking care continues to increase, necessitating comprehensive counseling about potential long-term effects of gender-affirming medical interventions on fertility. The objective of this narrative review was to examine fertility-related knowledge, attitudes, and decision-making (including factors influencing decisions, decision regret, and decision tools) among TGD youth. We searched PubMed, PsycInfo, and Google Scholar for original, peer-reviewed research investigating TGD youth attitudes and knowledge of fertility and fertility preservation, perspectives on fertility counseling and fertility preservation decision-making, as well as fertility-related decision tools. We reviewed 106 studies; eight were included in this narrative review. Four studies assessed TGD youth knowledge and attitudes of fertility and fertility preservation, three examined perspectives on fertility counseling and fertility preservation decision-making, and three discussed development of decision tools. Key findings were that: (1) many TGD youth are aware of potential fertility-related impacts of gender-affirming treatments, but there are still unmet informational needs, (2) some TGD youth report an interest in future biological parenthood, and of those who are not currently interested in biological parenthood, many acknowledge their desires may change over time, (3) ongoing discussions about fertility and fertility preservation are critical, and (4) decision tools are in development. In conclusion, TGD youth and their caregivers should receive ongoing, comprehensive fertility counseling and decision tools may be helpful to facilitate these discussions and decisions in each youth's gender-affirming care journey.

Estrogen exposure and skeletal health: Special populations and considerations

Estrogen is critical for bone health from puberty onwards. Various clinical scenarios in adolescence can impact skeletal exposure to estrogen during this vulnerable time. Primary ovarian insufficiency, premature menopause, and anorexia nervosa necessitate prompt evaluation, treatment, and replacement of estrogen in order to optimize accrual of peak bone mass. We have much still to learn about the skeletal impact of delaying puberty and gender affirming hormones in gender diverse individuals. While the choice of hormonal contraception in adolescence is often driven by patient preference and concerns about adherence, providers and patients much take the long-term impact on bone health into consideration. Key Concepts(1)Delayed, diminished or absent estrogen during adolescence has a negative impact on peak bone mass accrual.(2)Hormone replacement therapy is essential for patients with primary ovarian insufficiency and premature menopause.(3)Recovery from anorexia nervosa does not lead to a complete catch-up of bone density lost/not gained.(4)Not all hormonal contraception methods are created equal for the adolescent skeleton.(5)Skeletal health of trans youth is an emerging focus.

Dermatologic needs of transgender and gender diverse youth: A retrospective cohort study.

Several dermatologic concerns are known to disproportionally affect transgender and gender-diverse (TGD) adults, but little is known about dermatologic conditions in TGD youth. This study assesses the prevalence of acne, androgenic alopecia, scarring from gender-affirming procedures, and eczema in pediatric TGD patients seen at Boston Children's Hospital between April 2021 and April 2022. The results demonstrate that, for TGD youth, the studied dermatologic concerns are common, referral rates to dermatology are low, and acne is significantly associated with testosterone use. Future studies should examine additional dermatologic concerns and barriers to accessing dermatologic care for this historically underserved population.

Autistic and non-autistic transgender youth are similar in gender development and sexuality phenotypes.

Increasing rhetoric regarding the common intersection of autism and gender diversity has resulted in legislation banning autistic transgender youth from accessing standard of care supports, as well as legislative efforts banning all youth gender care in part justified by the proportional over-occurrence of autism. Yet, no study has investigated whether autistic and non-autistic transgender youth present fundamentally different gender-related phenotypes. To address this gap, we extensively characterized autism, gender diversity, and sexuality among autistic and non-autistic transgender binary youth (N = 66, Mage = 17.17, SDage = 2.12) in order to investigate similarities and/or differences in gender and sexuality phenotypes. Neither autism diagnostic status nor continuous autistic traits were significantly related to any gender or sexuality phenotypes. These findings suggest that the developmental and experiential features of gender diversity are very similar between autistic and non-autistic transgender adolescents. Future research is needed to determine whether the similarity in profiles is maintained over time into adulthood.

Research priorities in trans health: a Delphi-study.

Progress has been made in understanding trans health needs, but research priorities are often set by policy or healthcare professionals without trans input, which may not reflect public needs. Our study sought to identify trans health research priorities in France from both researchers and the trans community. Expert stakeholders (health and social sciences professionals, trans individuals, and their families) answered a three-round Delphi survey on trans health research priorities. The first round involved an open-ended questionnaire, analyzed qualitatively. In the second round, participants ranked research propositions from round one using a Likert scale. The study's second phase involved a two-hour workshop with experts and trans individuals. 53 participants (32% trans individuals/relatives, 60% health professionals) contributed 217 responses to open-ended questions, leading to 44 research priorities. After the two voting rounds, a total of five proposals reached a strong consensus cut-off and were considered as the main research priorities: evaluation of the effect of puberty blocker use in trans children and adolescents (95%), evaluation of the effect of supporting trans children and adolescents (92%), study of the support systems available for trans youth and their parents (86%), persistence of trans identity around puberty (prevalence, persistent persons characteristics) (86%), and needs assessment survey of the support for adolescents and their families (83%). Thirteen other proposals were considered moderate priorities. The main consensus in our French study concerned research on trans-youth care and support needs. Our results may guide further trans-health research that meets the public's needs and desires.

“We followed their lead”: Exploring relational change and support among caregivers of transgender and gender diverse youth

Transgender and gender diverse youth and young adults (TGDY) experience higher mental health morbidity, including self-harm, suicide ideation, and suicide attempts, as compared to cisgender peers. Support from family members is associated with improved mental health outcomes for TGDY. However, little is known about the process that caregivers who consider themselves supportive undergo and how caregiver-youth relationships evolve through a TGDY's gender journey. Through a reflexive thematic analysis of 14 interviews conducted with caregivers of TGDY from April–July 2022, we sought to understand how caregivers who considered themselves supportive of TGDY navigated shifting relationships with themselves, their children, and their communities. Applying theories of Ambiguous Loss and Thriving Through Relationships, findings coalesced around several themes including reflecting on change, re-negotiating interpersonal relationships, and educating through relationships. The gender journeys of TGDY required caregivers to navigate relationships with self (feeling loss and wrestling with worry for their child), negotiate relationships with others (disclosing to extended family and social networks), and educate themselves and others through relationships (connecting through personal narratives from other families, parents supporting parents, learning to advocate for their child). The process of caregivers learning to support their children was facilitated through profound intrapersonal and interpersonal reflection, connection, and community. Understanding this process is important to inform educational interventions and programs that help caregivers learn to support and advocate effectively for TGDY.

Move and Thrive: Development of an Adolescent Friendly and Inclusive Online Fitness Resource.

While physical activity (PA) is a strong protective factor for adolescents, many youth experience discrimination and intimidation in traditional fitness spaces. This is especially true for youth of color, youth in larger bodies, and transgender youth. This manuscript describes the development of Move and Thrive, an online resource for PA promotion designed specifically for adolescents prioritizing inclusivity and diversity. Working with Community and Youth Advisory Boards, we developed guiding principles of Move and Thrive: to create resources that are 1) youth and community driven; 2) inclusive of diverse representation; 3) body and weight neutral; 4) trauma informed; and 5) accessible. We developed a guide for PA instructors to use trauma informed approaches; avoid mention of weight talk or physical appearance; use gender inclusive language; and offer multiple options to improve accessibility. Specific care was taken to hire instructors diverse in body size, race, ethnicity, and gender identity. The first iteration of Move and Thrive was launched in March 2021, and the current resource contains 72 PA videos. Over the course of 12 months, the site had more than the site had over 9,000 views in over 40 countries, including six continents. Users have reported high levels of satisfaction with Move and Thrive, and physicians have responded enthusiastically to sharing Move and Thrive as a free resource for adolescents. University of Minnesota Move and Thrive Project is currently available on an ad-free YouTube Channel. We believe that Move and Thrive has the potential to reach populations historically excluded from PA resources.

Structural vulnerabilities and over-criminalization of LGBTQ + youth in the California justice system

PurposeLesbian, gay, bisexual, transgender, and queer (LGBTQ + ) youth are overly represented in the juvenile justice system, which stems from their structural vulnerability. LGBTQ + youths’ structural vulnerability, the societal criminalization of LGBTQ + individuals’ sexual and gender expression, and over-policing place these youth at greater risk of being charged with prostitution and related offenses. In turn, this study examines the relationship between youths’ gender identity, sexual orientation, structural vulnerability, and over-criminalization with the likelihood of being charged with prostitution or related charges, controlling for race/ethnicity and age. In doing so, the study offers insight to the mechanisms producing LGBTQ + youths’ structural vulnerability. MethodsThis study draws on the Criminalization of LGBQ/GNCT Youth data, which contains data on youth incarcerated in 46 of the 48 juvenile detention facilities in California in 2014 (N = 4,033). The data include information regarding youths’ sexuality, gender identity, race/ethnicity, child welfare system involvement, homelessness, and charges leading to detention. ResultsLGTBQ + youth had significantly higher odds of being incarcerated for prostitution and related charges than cisgender and straight youth. Experiencing family rejection and being detained more than once was significantly related to the odds of being incarcerated for prostitution and related charges. ConclusionLGBTQ + youth have significantly higher odds of being incarcerated for prostitution related offenses, which illuminates the nature of their structural vulnerability that place these youth at risk for justice involvement. Findings demonstrate a need for affirming LGBTQ + -specific services and improving the sexual orientation and gender identity and expression (SOGIE) data gathered in juvenile justice facilities.