Skip to main content

Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes

Abstract

Purpose of Review

This paper reviews the evolving body of research on the mental health of transgender and gender diverse (TGD) youth. Minority stress experiences in families, schools, and the community impact the health and well-being of this population due to experiences of stigma, discrimination, and rejection. Poor healthcare access and outcomes may be compounded in youth with intersectional identities.

Recent Findings

There is increasing evidence that gender-affirming interventions improve mental health outcomes for TGD youth. TGD youth report worse mental health outcomes in invalidating school and family environments and improved outcomes in affirming climates. TGD youth experience significant healthcare disparities, and intersectional clinical approaches are needed to increase access to affirmative care.

Summary

Providers can best support TGD youth by considering ways they can affirm these youth in their healthcare settings, and helping them access support in schools, family systems, and communities. Understanding the intersection of multiple minority identities can help providers address potential barriers to care to mitigate the health disparities seen in this population.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Challa M, Scott C, Turban JL. Epidemiology of pediatric gender identity. In: Forcier M, Van Schalkwyk G, Turban JL, editors. Pediatric gender identity: gender-affirming care for transgender & gender diverse youth. Cham: Springer International Publishing; 2020. p. 15–31.

    Chapter  Google Scholar 

  2. Hidalgo MA, Ehrensaft D, Tishelman AC, Clark LF, Garofalo R, Rosenthal SM, et al. The gender affirmative model: what we know and what we aim to learn. Hum Dev. 2013;56(5):285–90.

    Article  Google Scholar 

  3. Olson-Kennedy J. Mental health disparities among transgender youth: rethinking the role of professionals. JAMA Pediatr. 2016;170(5):423–4.

    PubMed  Article  Google Scholar 

  4. National LGBTQIA+ Health Education Center. LGBTQIA+ Glossary of Terms for Health Care Teams [Internet]. LGBTQIA+ Health Education Center. 2020 [cited 2020 Jul 26]. Available from: https://www.lgbthealtheducation.org/publication/lgbtqia-glossary-of-terms-for-health-care-teams/

  5. • Rafferty J, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, COMMITTEE ON ADOLESCENCE, SECTION ON LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTH AND WELLNESS. Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics. 2018;142(4) AAP policy statement that outlines most recent discussions and recommendations regarding many aspects of gender affirming care.

  6. Aitken M, Steensma TD, Blanchard R, VanderLaan DP, Wood H, Fuentes A, et al. Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med. 2015;12(3):756–63.

    PubMed  Article  Google Scholar 

  7. Spack NP, Edwards-Leeper L, Feldman HA, Leibowitz S, Mandel F, Diamond DA, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics. 2012;129(3):418–25.

    PubMed  Article  Google Scholar 

  8. Wood H, Sasaki S, Bradley SJ, Singh D, Fantus S, Owen-Anderson A, et al. Patterns of referral to a gender identity service for children and adolescents (1976–2011): age, sex ratio, and sexual orientation. J Sex Marital Ther. 2013;39(1):1–6.

    PubMed  Article  Google Scholar 

  9. Richards C, Bouman WP, Seal L, Barker MJ, Nieder TO, T’Sjoen G. Non-binary or genderqueer genders. Int Rev Psychiatry. 2016;28(1):95–102.

    PubMed  Article  Google Scholar 

  10. Harrison J, Grant J, Herman JL. A gender not listed here: genderqueers, gender rebels, and otherwise in the national transgender discrimination survey. LGBTQ Public Policy J Harv Kennedy Sch. 2012;2(1):13.

    Google Scholar 

  11. Reisner SL, Hughto JMW. Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample. Shiu C-S, editor. PLoS ONE. 2019;14(8):e0221583.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  12. James SE, Herman JL, Rankin, S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. Transgender Survey [Internet]. National Center for Transgender Equality; 2016 Dec [cited 2020 Jul 26]. Available from: http://www.ustranssurvey.org

  13. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.

    CAS  PubMed  Article  Google Scholar 

  14. Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pract. 2012;43(5):460–7.

    Article  Google Scholar 

  15. Morton MH, Dworsky A, Samuels GM. Missed opportunities: youth homelessness in America. National estimates. Chicago, IL: Chapin Hall at the University of Chicago; 2017. 16p.

    Google Scholar 

  16. Choi SK, Wilson BDM, Shelton J, Gates G. Serving our youth 2015: the needs and experiences of lesbian, gay, bisexual, transgender, and questioning youth experiencing homelessness. Los Angeles: The Williams Institute with True Colors Fund; 2015. 22p.

    Google Scholar 

  17. Morton MH, Dworsky A, Matjasko JL, Curry SR, Schlueter D, Chávez R, et al. Prevalence and correlates of youth homelessness in the United States. J Adolesc Health Off Publ Soc Adolesc Med. 2018;62(1):14–21.

    Article  Google Scholar 

  18. Johns MM, Lowry R, Andrzejewski J, Barrios LC, Demissie Z, McManus T, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students - 19 states and large urban school districts, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(3):67–71.

    PubMed  PubMed Central  Article  Google Scholar 

  19. Heck NC. The potential to promote resilience: piloting a minority stress-informed, GSA-based, mental health promotion program for LGBTQ youth. Psychol Sex Orientat Gend Divers. 2015;2(3):225–31.

    PubMed  PubMed Central  Article  Google Scholar 

  20. •• Golden RL, Oransky M. An intersectional approach to therapy with transgender adolescents and their families. Arch sex Behav. 2019;48(7):2011–25 Important intersectional clinical approach for providers to consider using with transgender youth.

    PubMed  Article  Google Scholar 

  21. Ferguson AD, Miville ML. It’s complicated: navigating multiple identities in small town America. J Clin Psychol. 2017;73(8):975–84.

    PubMed  Article  Google Scholar 

  22. Edwards-Leeper L, Leibowitz S, Sangganjanavanich VF. Affirmative practice with transgender and gender nonconforming youth: expanding the model. Psychol Sex Orientat Gend Divers. 2016;3(2):165–72.

    Article  Google Scholar 

  23. Keo-Meier C, Ehrensaft D. The gender affirmative model: an interdisciplinary approach to supporting transgender and gender expansive children. Washington DC: American Psychological Association; 2018.

    Book  Google Scholar 

  24. Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs. 2010;23(4):205–13.

    PubMed  Article  Google Scholar 

  25. Wiepjes CM, Nota NM, de Blok CJM, Klaver M, de Vries ALC, Wensing-Kruger SA, et al. The Amsterdam cohort of gender dysphoria study (1972–2015): trends in prevalence, treatment, and regrets. J Sex Med. 2018;15(4):582–90.

    PubMed  Article  Google Scholar 

  26. Chung K, Rhoads S, Rolin A, Sackett-Taylor AC, Forcier M. Treatment paradigms for adolescents: gender-affirming hormonal care. In: Forcier M, Van Schalkwyk G, Turban JL, editors. Pediatric gender identity: gender-affirming care for transgender & gender diverse youth. Cham: Springer International Publishing; 2020. p. 187–202.

    Chapter  Google Scholar 

  27. Herman JL, Flores AR, Brown TN, Wilson BD, Conron KJ. Age of individuals who identify as transgender in the United States Los Angeles: the Williams Institute; 2017. 13p.

    Google Scholar 

  28. Littman L. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS One. 2018;13(8):e0202330.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  29. Restar AJ. Methodological critique of Littman’s (2018) parental-respondents accounts of rapid-onset gender dysphoria. Arch Sex Behav. 2020;49(1):61–6.

    PubMed  Article  Google Scholar 

  30. Costa AB. Formal comment on: parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS One. 2019;14(3):e0212578.

    Article  CAS  Google Scholar 

  31. World Professional Association for Transgender Health Board of Directors. WPATH Position on Rapid-Onset Gender Dysphoria [Internet]. World Professional Association for Transgender Health; 2018 Sep [cited 2020 Jul 26] p. 1. Available from: https://www.wpath.org/media/cms/Documents/Public%20Policies/2018/9_Sept/WPATH%20Position%20on%20Rapid-Onset%20Gender%20Dysphoria_9-4-2018.pdf

  32. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Youth risk behavior surveillance — United States, 2017. MMWR Surveill Summ. 2018;67(8):1–114.

    PubMed  PubMed Central  Article  Google Scholar 

  33. de Vries ALC, Noens ILJ, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord. 2010;40(8):930–6.

    PubMed  PubMed Central  Article  Google Scholar 

  34. Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS. Prevalence of autism spectrum disorder and attention-deficit hyperactivity disorder amongst individuals with gender dysphoria: a systematic review. J Autism Dev Disord. 2020;50(3):695–706.

    PubMed  Article  Google Scholar 

  35. Strang JF, Janssen A, Tishelman A, Leibowitz SF, Kenworthy L, McGuire JK, et al. Revisiting the link: evidence of the rates of autism in studies of gender diverse individuals. J Am Acad Child Adolesc Psychiatry. 2018;57(11):885–7.

    PubMed  Article  Google Scholar 

  36. • Strang JF, Meagher H, Kenworthy L, de Vries ALC, Menvielle E, Leibowitz S, et al. Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. J Clin Child Adolesc Psychol Off J Soc Clin Child Adolesc Psychol Am Psychol Assoc Div 53. 2018;47(1):105–15 Study that developed clinical consensus guidelines for assessment and care of adolescents with co-occurring Autism Spectrum Disorder and Gender Dysphoria.

    Google Scholar 

  37. Strang JF, Knauss M, van der Miesen A, McGuire JK, Kenworthy L, Caplan R, et al. A clinical program for transgender and gender-diverse neurodiverse/autistic adolescents developed through community-based participatory design. J Clin Child Adolesc Psychol Off J Soc Clin Child Adolesc Psychol Am Psychol Assoc Div. 2020;53:1–16.

    Google Scholar 

  38. Hall JP, Batza K, Streed CG, Boyd BA, Kurth NK. Health disparities among sexual and gender minorities with autism spectrum disorder. J Autism Dev Disord. 2020;50(8):3071–7.

    PubMed  Article  Google Scholar 

  39. Olson KR, Durwood L, DeMeules M, McLaughlin KA. Mental health of transgender children who are supported in their identities. Pediatrics. 2016;137(3):e20153223.

    PubMed  PubMed Central  Article  Google Scholar 

  40. • Durwood L, McLaughlin KA, Olson KR. Mental health and self-worth in socially transitioned transgender youth. J Am Acad Child Adolesc Psychiatry. 2017;56(2):116–123.e2 Recent study examining well being of socially transitioned transgender children, showing depression and self-worth ratings did not significantly differ from cisgender controls.

    PubMed  Article  Google Scholar 

  41. Olson KR, Key AC, Eaton NR. Gender cognition in transgender children. Psychol Sci. 2015;26(4):467–74.

    PubMed  Article  Google Scholar 

  42. Fast AA, Olson KR. Gender development in transgender preschool children. Child Dev. 2018;89(2):620–37.

    PubMed  Article  Google Scholar 

  43. Gülgöz S, Glazier JJ, Enright EA, Alonso DJ, Durwood LJ, Fast AA, et al. Similarity in transgender and cisgender children’s gender development. Proc Natl Acad Sci U S A. 2019;116(49):24480–5.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  44. • Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903 Endocrine Society’s official clinical practice guidelines regarding gender-affirming care.

    PubMed  Article  Google Scholar 

  45. Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A. Puberty suppression in transgender children and adolescents. Lancet Diabetes Endocrinol. 2017;5(10):816–26.

    PubMed  Article  Google Scholar 

  46. de Vries ALC, Steensma TD, Doreleijers TAH, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011;8(8):2276–83.

    PubMed  Article  Google Scholar 

  47. de Vries ALC, McGuire JK, Steensma TD, Wagenaar ECF, Doreleijers TAH, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134(4):696–704.

    PubMed  Article  Google Scholar 

  48. • van der Miesen AIR, Steensma TD, de Vries ALC, Bos H, Popma A. Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers. J Adolesc Health. 2020;66(6):699–704 Recent study evaluating psychological functioning of transgender youth after receiving pubertal suppression and hormone therapy, compared to control group.

    PubMed  Article  Google Scholar 

  49. Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics. 2020;145(2).

  50. Nguyen HB, Chavez AM, Lipner E, Hantsoo L, Kornfield SL, Davies RD, et al. Gender-affirming hormone use in transgender individuals: impact on behavioral health and cognition. Curr Psychiatry Rep. 2018;20(12):110.

    PubMed  PubMed Central  Article  Google Scholar 

  51. • Kuper LE, Stewart S, Preston S, Lau M, Lopez X. Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics. 2020;145(4):e20193006 Study demonstrating large improvements in body dissatisfaction and modest improvements in mental health after receiving one year of gender affirming hormone therapy.

    PubMed  Article  Google Scholar 

  52. Colizzi M, Costa R, Pace V, Todarello O. Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. J Sex Med. 2013;10(12):3049–58.

    PubMed  Article  Google Scholar 

  53. Heylens G, Verroken C, Cock SD, T’Sjoen G, Cuypere GD. Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder. J Sex Med. 2014;11(1):119–26.

    PubMed  Article  Google Scholar 

  54. Colizzi M, Costa R, Todarello O. Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: results from a longitudinal study. Psychoneuroendocrinology. 2014;39:65–73.

    CAS  PubMed  Article  Google Scholar 

  55. Oda H, Kinoshita T. Efficacy of hormonal and mental treatments with MMPI in FtM individuals: cross-sectional and longitudinal studies. BMC Psychiatry. 2017;17(1):256.

    PubMed  PubMed Central  Article  Google Scholar 

  56. Keo-Meier CL, Herman LI, Reisner SL, Pardo ST, Sharp C, Babcock JC. Testosterone treatment and MMPI-2 improvement in transgender men: a prospective controlled study. J Consult Clin Psychol. 2015;83(1):143–56.

    PubMed  Article  Google Scholar 

  57. Mookerjee VG, Brower JP, Kwan D. Gender-affirming surgical care. In: Forcier M, Van Schalkwyk G, Turban JL, editors. Pediatric gender identity: gender-affirming care for transgender & gender diverse youth. Cham: Springer International Publishing; 2020. p. 219–29.

    Chapter  Google Scholar 

  58. Marinkovic M, Newfield RS. Chest reconstructive surgeries in transmasculine youth: experience from one pediatric center. Int J Transgenderism. 2017;18(4):376–81.

    Article  Google Scholar 

  59. • Olson-Kennedy J, Warus J, Okonta V, Belzer M, Clark LF. Chest reconstruction and chest dysphoria in transmasculine minors and young adults: comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatr. 2018;172(5):431–6 Recent longitudinal study examining outcomes of transgender youth after receiving top surgery -- notably none of the adolescent participants reported regret.

    PubMed  PubMed Central  Article  Google Scholar 

  60. Seal LJ. A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria. Ann Clin Biochem. 2016;53(1):10–20.

    CAS  PubMed  Article  Google Scholar 

  61. Chen D, Simons L, Johnson EK, Lockart BA, Finlayson C. Fertility preservation for transgender adolescents. J Adolesc Health. 2017;61(1):120–3.

    PubMed  PubMed Central  Article  Google Scholar 

  62. Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP. Low fertility preservation utilization among transgender youth. J Adolesc Health. 2017;61(1):40–4.

    PubMed  Article  Google Scholar 

  63. Strang JF, Jarin J, Call D, Clark B, Wallace GL, Anthony LG, et al. Transgender youth fertility attitudes questionnaire: measure development in nonautistic and autistic transgender youth and their parents. J Adolesc Health Off Publ Soc Adolesc Med. 2018;62(2):128–35.

    Article  Google Scholar 

  64. Chen D, Kyweluk MA, Sajwani A, Gordon EJ, Johnson EK, Finlayson CA, et al. Factors affecting fertility decision-making among transgender adolescents and young adults. LGBT Health. 2019;6(3):107–15.

    PubMed  PubMed Central  Article  Google Scholar 

  65. Nahata L, Campo-Engelstein LT, Tishelman A, Quinn GP, Lantos JD. Fertility preservation for a transgender teenager. 2018;142(3):9.66.

  66. Olson-Kennedy J, Okonta V, Clark LF, Belzer M. Physiologic response to gender-affirming hormones among transgender youth. J Adolesc Health. 2018;62(4):397–401.

    PubMed  Article  Google Scholar 

  67. Jarin J, Pine-Twaddell E, Trotman G, Stevens J, Conard LA, Tefera E, et al. Cross-sex hormones and metabolic parameters in adolescents with gender dysphoria. Pediatrics. 2017;139(5).

  68. Vlot MC, Klink DT, den Heijer M, Blankenstein MA, Rotteveel J, Heijboer AC. Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents. Bone. 2017;95:11–9.

    CAS  PubMed  Article  Google Scholar 

  69. Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab. 2015;100(2):E270–5.

    CAS  PubMed  Article  Google Scholar 

  70. Rider GN, McMorris BJ, Gower AL, Coleman E, Eisenberg ME. Health and care utilization of transgender and gender nonconforming youth: a population-based study. Pediatrics. 2018;141(3).

  71. Samuels EA, Tape C, Garber N, Bowman S, Choo EK. “Sometimes you feel like the freak show”: a qualitative assessment of emergency care experiences among transgender and gender-nonconforming patients. Ann Emerg Med. 2018;71(2):170–182.e1.

    PubMed  Article  Google Scholar 

  72. Chisolm-Straker M, Jardine L, Bennouna C, Morency-Brassard N, Coy L, Egemba MO, et al. Transgender and gender nonconforming in emergency departments: a qualitative report of patient experiences. Transgender Health. 2017;2(1):8–16.

    PubMed  PubMed Central  Article  Google Scholar 

  73. Fisher CB, Fried AL, Desmond M, Macapagal K, Mustanski B. Perceived barriers to HIV prevention services for transgender youth. LGBT Health. 2018;5(6):350–8.

    PubMed  PubMed Central  Article  Google Scholar 

  74. DeJonckheere M, Zhao A, Lane J, Plegue MA, Ranalli L, Wagner E, et al. Results of a national text message poll of youth: perspectives on primary care. J Adolesc Health Off Publ Soc Adolesc Med. 2020.

  75. Eisenberg ME, McMorris BJ, Rider GN, Gower AL, Coleman E. “It’s kind of hard to go to the doctor’s office if you’re hated there.” A call for gender-affirming care from transgender and gender diverse adolescents in the United States. Health Soc Care Community. 2020;28(3):1082–9.

    PubMed  PubMed Central  Article  Google Scholar 

  76. Taliaferro LA, Harder BM, Lampe NM, Carter SK, Rider GN, Eisenberg ME. Social connectedness factors that facilitate use of healthcare services: comparison of transgender and gender nonconforming and cisgender adolescents. J Pediatr. 2019;211:172–8.

    PubMed  PubMed Central  Article  Google Scholar 

  77. Clark BA, Veale JF, Townsend M, Frohard-Dourlent H, Saewyc E. Non-binary youth: access to gender-affirming primary health care. Int J Transgenderism. 2018;19(2):158–69.

    Article  Google Scholar 

  78. Macapagal K, Bhatia R, Greene GJ. Differences in healthcare access, use, and experiences within a community sample of racially diverse lesbian, gay, bisexual, transgender, and questioning emerging adults. LGBT Health. 2016;3(6):434–42.

    PubMed  PubMed Central  Article  Google Scholar 

  79. Rodgers SM. Transitional age lesbian, gay, bisexual, transgender, and questioning youth: issues of diversity, integrated identities, and mental health. Child Adolesc Psychiatr Clin N Am. 2017;26(2):297–309.

    PubMed  Article  Google Scholar 

  80. Stevens J, Gomez-Lobo V, Pine-Twaddell E. Insurance coverage of puberty blocker therapies for transgender youth. Pediatrics. 2015 Dec 1;136(6):1029–31.

    PubMed  Article  Google Scholar 

  81. Lopez CM, Solomon D, Boulware SD, Christison-Lagay ER. Trends in the use of puberty blockers among transgender children in the United States. J Pediatr Endocrinol Metab JPEM. 2018;31(6):665–70.

    PubMed  Article  Google Scholar 

  82. Lykens JE, LeBlanc AJ, Bockting WO. Healthcare experiences among young adults who identify as Genderqueer or nonbinary. LGBT Health. 2018;5(3):191–6.

    PubMed  PubMed Central  Article  Google Scholar 

  83. Gridley SJ, Crouch JM, Evans Y, Eng W, Antoon E, Lyapustina M, et al. Youth and caregiver perspectives on barriers to gender-affirming health care for transgender youth. J Adolesc Health Off Publ Soc Adolesc Med. 2016;59(3):254–61.

    Article  Google Scholar 

  84. De Pedro KT, Shim-Pelayo H, Bishop C. Exploring physical, nonphysical, and discrimination-based victimization among transgender youth in California public schools. Int J Bullying Prev. 2019;1(3):218–26.

    Article  Google Scholar 

  85. Kosciw JG, Greytak EA, Zongrone AD, Clark CM, Truong NL. The 2017 National School Climate Survey: the experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. New York: GLSEN; 2018. p. 2018, 165p.

    Google Scholar 

  86. Eisenberg ME, Gower AL, Nic Rider G, McMorris BJ, Coleman E. At the intersection of sexual orientation and gender identity: variations in emotional distress and bullying experience in a large population-based sample of U.S. adolescents. J LGBT Youth. 2019;16(3):235–54.

    PubMed  PubMed Central  Article  Google Scholar 

  87. Sterzing PR, Ratliff GA, Gartner RE, McGeough BL, Johnson KC. Social ecological correlates of polyvictimization among a bational sample of transgender, genderqueer, and cisgender sexual minority adolescents. Child Abuse Negl. 2017;67:1–12.

    PubMed  Article  Google Scholar 

  88. Murchison GR, Agénor M, Reisner SL, Watson RJ. School restroom and locker room restrictions and sexual assault risk among transgender youth. Pediatrics. 2019;143(6).

  89. Witcomb GL, Claes L, Bouman WP, Nixon E, Motmans J, Arcelus J. Experiences and psychological wellbeing outcomes associated with bullying in treatment-seeking transgender and gender-diverse youth. LGBT Health. 2019;6(5):216–26.

    PubMed  Article  Google Scholar 

  90. Price-Feeney M, Jones LM, Ybarra ML, Mitchell Kimberly J. The relationship between bias-based peer victimization and depressive symptomatology across sexual and gender identity. Psychol Violence. 2018;8(6):680–91.

    PubMed  PubMed Central  Article  Google Scholar 

  91. Hatchel T, Marx R. Understanding intersectionality and resiliency among transgender adolescents: exploring pathways among peer victimization, school belonging, and drug use. Int J Environ Res Public Health. 2018;19:15(6).

    Google Scholar 

  92. Colvin S, Egan JE, Coulter RWS. School climate & sexual and gender minority adolescent mental health. J Youth Adolesc. 2019;48(10):1938–51.

    PubMed  Article  Google Scholar 

  93. Genel M. Transgender athletes: how can they be accommodated? Curr Sports Med Rep. 2017;16(1):12–3.

    PubMed  Article  Google Scholar 

  94. Pistella J, Ioverno S, Rodgers MA, Russell ST. The contribution of school safety to weight-related health behaviors for transgender youth. J Adolesc. 2020;78:33–42.

    PubMed  Article  Google Scholar 

  95. Ross-Reed DE, Reno J, Peñaloza L, Green D, FitzGerald C. Family, school, and peer support are associated with rates of violence victimization and self-harm among gender minority and cisgender youth. J Adolesc Health Off Publ Soc Adolesc Med. 2019;65(6):776–83.

    Article  Google Scholar 

  96. Klein A, Golub SA. Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults. LGBT Health. 2016;3(3):193–9.

    PubMed  Article  Google Scholar 

  97. Wheeler NL, Langton T, Lidster E, Dallos R. Understanding more about how young people make sense of their siblings changing gender identity: how this might affect their relationships with their gender-diverse siblings and their experiences. Clin Child Psychol Psychiatry. 2019;24(2):258–76.

    PubMed  Article  Google Scholar 

  98. Katz-Wise SL, Ehrensaft D, Vetters R, Forcier M, Austin SB. Family functioning and mental health of transgender and gender-nonconforming youth in the trans teen and family narratives project. J Sex Res. 2018;55(4–5):582–90.

    PubMed  PubMed Central  Article  Google Scholar 

  99. Handler T, Hojilla JC, Varghese R, Wellenstein W, Satre DD, Zaritsky E. Trends in referrals to a pediatric transgender clinic. Pediatrics. 2019;144(5).

  100. Chmielewski JF, Belmonte KM, Fine M, Stoudt BG. Intersectional inquiries with LGBTQ and gender nonconforming youth of color: participatory research on discipline disparities at the race/sexuality/gender nexus. In: Skiba RJ, Mediratta K, Rausch MK, editors. Inequality in school discipline: research and practice to reduce disparities. New York: Palgrave Macmillan US; 2016. p. 171–88.

    Chapter  Google Scholar 

  101. Eastwood EA, Nace AJ, Hirshfield S, Birnbaum JM. Young transgender women of color: homelessness, poverty, childhood sexual abuse and implications for hiv care. AIDS Behav. 2019.

  102. Raynor PA, Nation A, Outlaw F. Exploring substance use and mental health for minority transgender youth: implications for advanced practice nurses. J Am Assoc Nurse Pract. 2020;32(3):229–43.

    PubMed  Article  Google Scholar 

  103. Goldenberg T, Jadwin-Cakmak L, Popoff E, Reisner SL, Campbell BA, Harper GW. Stigma, gender affirmation, and primary healthcare use among black transgender youth. J Adolesc Health. 2019;65(4):483–90.

    PubMed  PubMed Central  Article  Google Scholar 

  104. Fox KR, Choukas-Bradley S, Salk RH, Marshal MP, Thoma BC. Mental health among sexual and gender minority adolescents: examining interactions with race and ethnicity. J Consult Clin Psychol. 2020;88(5):402–15.

    PubMed  PubMed Central  Article  Google Scholar 

  105. Neblett EW, Rivas-Drake D, Umaña-Taylor AJ. The promise of racial and ethnic protective factors in promoting ethnic minority youth development. Child Dev Perspect. 2012;6(3):295–303.

    Article  Google Scholar 

  106. Hirschtritt ME, Noy G, Haller E, Forstein M. LGBT-specific education in general psychiatry residency programs: a survey of program directors. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry. 2019;43(1):41–5.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cynthia J. Telingator.

Ethics declarations

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Child and Adolescent Disorders

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Call, D.C., Challa, M. & Telingator, C.J. Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes. Curr Psychiatry Rep 23, 33 (2021). https://doi.org/10.1007/s11920-021-01245-9

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11920-021-01245-9

Keywords

  • Transgender
  • Gender diverse
  • Intersectionality
  • Disparities
  • Youth
  • Gender-affirmative care