In Focus: Transgender Youth’s Mental Health

In Focus: Transgender Youth’s Mental Health

By Meg D. Bishop, PhD & Jessica N. Fish, PhD

Transgender Youth Mental Health Inequities

Transgender and gender diverse youth (i.e., TGDY) are young people whose innate sense of their gender varies from that which they were assigned at birth. Over 300,000 teens ages 13-17 years old in the United States are TGDY (Herman et al., 2022). Due to gender-based stigma (e.g., discrimination, victimization) and barriers to medical care, TGDY face disproportionate risk for mental health problems including depression, suicidality, and anxiety (Price-Feeney et al., 2020; Thoma et al., 2019). More than one third of TGDY report a past-year suicide attempt —approximately three times the rate of cisgender youth (Johns, 2019). Given that TGD people are increasingly disclosing their identities at younger ages, addressing TGDY mental health inequities is an urgent priority for child and adolescent psychology.

Mental Health Inequities are Rooted in Stigma

Although TGDY report higher rates of mental health symptomology, it is crucial to note that there is nothing inherently risky about TGDY identity; rather, mental health inequities result from stigma related to gender diversity, such as rejection and discrimination. With support and access to gender-affirming services, TGDY mental health is similar to that of their peers (Durwood et al., 2017). This reality is backed by a robust science demonstrating the ways that eradicating gender-based discrimination in family, school, and healthcare environments drastically reduces mental health inequities.

Numerous studies show that family affirmation of gender identity is linked to improved psychological outcomes for TGDY (Durwood et al., 2021; Kuvalanka et al., 2017). For young (prepubescent) TGDY, family affirmation means supporting social transition by allowing TGDY to use their affirmed names and pronouns, wear clothes that best express their gender, and play with peers and toys with which they are comfortable. Prepubescent TGDY whose families affirm their social transition report rates of depression comparable to their non-TGDY peers and only modestly higher rates of anxiety (Durwood et al., 2017; Olson et al., 2016).

As do all young people, TGDY benefit from healthcare that is evidence-based, responsive, and supportive. Gender-affirming medical care (i.e., GAMC) is comprised of social, psychological, behavioral, and medical treatments to align TGDY gender presentation and expression with their sense of self (Alberti et al., 2023). For prepubescent TGDY, GAMC facilitates social transitions such as shifts in names, pronouns, appearance (e.g., clothing, hair), and utilization of gendered social spaces (e.g., bathrooms, locker rooms). Approaching puberty, TGDY and their caretakers may consult medical and mental health providers to consider medications to suppress puberty. These medications create temporary pauses to the development of secondary sex characteristics (e.g., voice, hair, and body composition) that may elicit or exacerbate gender dysphoria (Coleman et al., 2022). In consultation with healthcare providers and caretakers, some adolescents may receive gender-affirming hormone therapies that produce secondary sex characteristics aligned with their gender identity. GAMC is developmentally appropriate and medically necessary for TGDY who meet internationally recognized guidelines for treatment (Coleman et al., 2022; Hembree et al., 2017). It is recommended by all major medical organizations (Alberti et al., 2023). When indicated, GAMC is associated with improved mental health for TGDY. For example, recent studies show that TGDY who receive GAMC report subjective well-being, quality of life, and suicidality rates that mirror their same-aged peers from the general population (de Vries et al., 2014; van der Miesen et al., 2020).

Schools can also be sites for addressing TGDY mental health inequities. Research suggests four main strategies for supporting LGBTQ+ students (Bishop et al., 2023): 1) Inclusive, enumerated state or local policies that name groups protected in schools (e.g., through non-discrimination or anti-bullying policies); 2) Professional development to train educators to support LGBTQ+ youth; 3) Student-led organizations like Gender-Sexuality Alliances (i.e., GSAs) that create positive school climates; and 4) Access to information related to LGBTQ+ identity, such as LGBTQ+-inclusive curricula or designated safe school personnel. TGDY who attend schools that enact these strategies report markedly higher wellbeing, mental health, and academic achievement (Russell et al., 2021). Notably, these safe-school strategies improve wellbeing for all students, not only for LGBTQ+ youth (Poteat et al., 2020).

Anti-Transgender Legislation Perpetuates Stigma and Exacerbates Health Disparities

Despite a robust and definitive science documenting the benefits of gender-affirming supports in family, healthcare, and school settings, there has been a recent dramatic surge in anti-transgender legislation that perpetuates, rather than reduces, TGDY mental health inequities. In 2023 alone, more than 500 bills across 49 states have been proposed to limit the rights of transgender people, with the majority targeting TGDY. These bills include bans on gender-affirming healthcare, inclusive education, participation in sports, and bathroom use. As of this writing, at least 21 states have enacted anti-transgender laws (Trans Legislation Tracker, 2023).

Legislative efforts to limit TGDY’s access to affirming family, healthcare, and school resources counter scientific consensus from all major medical organizations and exacerbate mental health inequities (Alberti et al., 2023). A recent study documented an increase in the number of LGBTQ+ youth who contacted crisis text lines in states that proposed anti-LGBTQ legislation (Parris et al., 2021). In another recent study, 86% of TGDY reported that recent debates regarding anti-transgender legislation negatively impacted their mental health; 29% reported feeling unsafe going to the doctor as a result of these debates (Trevor Project, 2023).

Eliminate Anti-Transgender Legislation to Support Transgender Youth’s Mental Health

The instantiation of laws and policies that strip TGDY of their basic civil rights to health, education, and freedom contradict evidence-based recommendations from scientists, physicians, and educators. The child and adolescent psychology community must advocate for strategies that support the positive development and wellbeing of TGDY, including the use of names, pronouns, and access to gendered spaces that affirm TGDY. In medical settings, we must eliminate barriers to the effective healthcare that TGDY deserve. At school, we should enact inclusive and enumerated policies, teach affirming curricula, prioritize TGDY-focused professional development, and support TGDY-led spaces. Crucially, at the policy level, we must enact legislation that promotes, rather than threatens, TGDY health. The science is clear—developmentally appropriate gender-affirming care is a life-saving measure that TGDY deserve.

References

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