NCFR Research Summary

More than 100 pieces of legislation targeting the transgender community in more than 30 states in the U.S. have been introduced so far in 2021¹. The majority of these bills would negatively impact transgender children, adolescents, and their families in that they limit the rights, opportunities, and care of transgender youth, who are already at increased risk for negative mental health outcomes.

Family Science research has revealed the critical benefits of familial and community support and affirmation for transgender children and adolescents. Family acceptance in general is associated with better well-being among transgender youth, while family support for gender identity, in particular, has been linked to fewer depressive symptoms and reduced suicidal ideation.^{2, 3} Recent studies of socially transitioned transgender youth growing up in affirming households have revealed normative or only slightly elevated rates of internalizing symptoms related to anxiety and depression. ^{4, 5, 6, 7} The ability to use one’s chosen name in various contexts, including at home with their families and in school with their peers, has been associated with lower depression, suicidal ideation, and suicidal behavior among transgender youth.^8. Further, inclusive school policies, such as allowing transgender youth to participate on sports teams and to use bathrooms and locker rooms that align with their gender identities, signal community support and are related to higher levels of feelings of school belongingness among transgender students.⁹ Although research to understand the complex issues related to transgender youth’s well-being and family relationships is still emerging, gender-affirming care has been well-documented to show life-saving benefits to transgender youth through improved psychological health, reduced gender dysphoria,¹⁰ and decreased suicidality and suicide attempts.^{11, 12, 13} Affirming parents can play a critical role in facilitating quality care for young people, supporting medical decision making, and negotiating medical environments.¹⁴ However, if families or communities are not supportive, youth can suffer from rejection or ambiguous losses.^{15, 16}

Quality gender-affirming care for youth may include, but is not limited to, individual and family counseling, social support navigating school and community transitions, puberty blocking hormones to prevent the development of distressing secondary sex characteristics, gender-affirming hormones to stimulate puberty of the affirmed gender, and, potentially, surgical interventions for older adolescents/young adults.^{17, 18} Promising therapeutic and programmatic approaches have made inroads at supporting transgender youth and their family members to navigate medical decisions, dynamics within the family and relationships with extended family and communities.¹⁹ A significant body of evidence finds improvement in psychological health for youth after initiating puberty blocking, and continued improvement after gender affirming hormones commence.^{10, 11, 20} Although physical interventions are not completely without risk,²¹ the developing body of research suggests that the delay of puberty for transgender youth and subsequent use of gender affirming hormones has relatively small side effects when compared to the significant reduction in suicidality,^{12, 13} which is among the leading causes of death among youth ages 11 to 19, and is especially elevated for transgender youth. Given the rapidly developing knowledge base regarding gender-affirming services, transgender youth and their families should be guided by competent clinical and medical professionals rather than restricted by uniform legislation in these matters.

Research further suggests that, even if the proposed legislative efforts do not ultimately become law, the introduction of such legislation may be harmful, in that the resulting public discourse communicates stigma against transgender youth, which could lead to increases in their experiences of bullying and harassment.²²

Research published by NCFR members and other leading scholars with expertise on the health and well-being of LGBTQ youth demonstrates the importance of family and community support, coupled with competent medical and psychological care, in the affirmation of transgender children and adolescents.

Findings for this research statement were gathered from the references below. See NCFR’s updated Transgender Individuals and Families resource collection for more information.

References

¹Freedom For All Americans. (2021, April 23). Tracking LBGT-related legislation nationwide.https://freedomforallamericans.org/legislative-tracker/

²McGuire, J. K., & Fish, J. N. (2018, November). Family gender environment links to psychological well-being. Paper presented at National Council on Family Relations, San Diego.

³Brown, C., Porta, C. M., Eisenberg, M. E., McMorris, B. J., & Sieving, R. E. (2020). Family relationships and the health and well-being of transgender and gender-diverse youth: A critical review. LGBT Health, 7, 407-419. https://doi.org/10.1089/lgbt.2019.0200

⁴Durwood, L., McLaughlin, K. A., & Olson K.R. (2016). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child and Adolescent Psychiatry, 56(2), 116–123. https://doi.org/10.1016/j.jaac.2016.10.016

⁵Gibson, D. J., Glazier, J. J., & Olson, K. R. (2021). Evaluation of anxiety and depression in a community sample of transgender youth. Journal of the American Medical Association, 4(4), Article e214739. doi:10.1001/jamanetworkopen.2021.4739

⁶Kuvalanka, K. A., Weiner, J. L., Munroe, C., Goldberg, A. E., & Gardner, M. (2017). Trans and gender-nonconforming children and their caregivers: Gender presentations, peer relations, and well-being at baseline. Journal of Family Psychology, 31(7), 889-899. https://doi.org/10.1037/fam0000338

⁷Olson, K. R., Durwood, L., DeMeules, M., McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), Article e20153223. https://doi.org/10.1542/peds.2015-3223

⁸Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63(4), p. 503-505. https://doi.org/10.1016/j.jadohealth.2018.02.003

⁹Kosciw, J. G., Clark, C. M., Truong, N. L., & Zongrone, A. D. (2020). The 2019 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. New York: GLSEN. www.glsen.org/sites/default/files/2021-04/NSCS19-FullReport-032421-Web_0.pdf

¹⁰de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696-704. https://doi.org/10.1542/peds.2013-2958

¹¹van der Miesen, A. I. R., Steensma, T. D., de Vries, A. L. C., Bos, H., & Popma, A. (2020). Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers. Journal of Adolescent Health, 66(6), 699-704. https://doi.org/10.1016/j.jadohealth.2019.12.018  

¹²Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), Article e20191725. https://doi.org/10.1542/peds.2019-1725

¹³Chew, D., Anderson, J., Williams, K., May, T., & Pang, K. (2018). Hormonal treatment in young people with gender dysphoria: A systematic review. Pediatrics, 141(4), Article e20173742. https://doi.org/10.1542/peds.2017-3742   

¹⁴Daley, T., Grossoehme, D., McGuire, J. K., Corathers, S, Conard, L., & Lipstien, E. (2019). "I couldn't see a downside": Decision-making about gender-affirming hormone therapy. Journal of Adolescent Health, 65(2), 274-279. https://doi.org/10.1016/j.jadohealth.2019.02.018

¹⁵Catalpa, J. M., & McGuire, J. K. (2018). Family boundary ambiguity among transgenderyouth. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 67, 88-103. https://doi.org/10.1111/fare.12304 

¹⁶Okrey Anderson, S., & McGuire, J. K. (2021). "I feel like God doesn't like me": Faith and ambiguous loss among transgender youth. Family Relations: An Interdisciplinary Journal of Applied Family Science. Advanced online publication. https://doi.org/10.1111/fare.12536

¹⁷Olson-Kennedy, J., Chan, Y.-M., Garofalo, R., Spack, N., Chen, D., Clark, L., Ehrensaft, D., Hidalgo, M., Tishelman, A., & Rosenthal, S. (2019). Impact of early medical treatment for transgender youth: Protocol for the Longitudinal, Observational Trans Youth Care Study. Journal of Medical Internet Research-Research Protocols, 8(7), Article e14434. https://doi.org/10.2196/14434  

¹⁸Schagen, S. E. E., Cohen-Kettenis, P. T., Delemarre-van de Waal, H. A., & Hannema, S. E. (2016). Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. The Journal of Sexual Medicine, 13(7), 1125-1132. https://doi.org/10.1016/j.jsxm.2016.05.004  

¹⁹Diamond, G. M., Boruchovitz-Zamir, R., Gat, I. & Nir-Gottlieb, O. (2019). Relationship-focused therapy for sexual and gender minority individuals and their parents. In. J. E. Pachankis, John & S. Safren (Eds.), Handbook of evidence-based mental health practice with sexual and gender minorities (pp. 430-456). Oxford University Press.

²⁰Kuper, L. E., Stewart, S., Preston, S., Lau, M., & Lopez, X. (2020). Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics, 145(4), Article e20193006. https://doi.org/10.1542/peds.2019-3006  

²¹Jensen, R. K., Jensen, J. K., Simons, L. K., Chen, D., Rosoklija, I., & Finlayson, C. A. (2019). Effect of concurrent gonadotropin-releasing hormone agonist treatment on dose and side effects of gender-affirming hormone therapy in adolescent transgender patients. Transgender Health, 4(1), 300-303. https://doi.org/10.1089/trgh.2018.0061  

²²Hatzenbuehler, M. L., Shen, Y., Vandewater, E. A., & Russell, S. T. (2019). Proposition 8 and homophobic bullying in California. Pediatrics, 143(6), Article e20182116. https://doi.org/10.1542/peds.2018-2116