Monday, June 13, 2022

Supporting transgender and gender questioning teens

 - Jennifer Middleton, MD, MPH

A new study has found that transgender and gender questioning youth are at higher risk of several serious health risks, including bullying and suicidal thoughts, compared to their cisgender peers. 

The study's researchers pulled data from the Youth Risk Behavior Survey, which is administered across most of the United States every other year. In 2017, 15 states added a question about transgender identity. The researchers looked at the survey results from 2017 and 2019 in those states and compared reported risk experiences between transgender and gender questioning youth to the reported risk experiences from cisgender youth:

[T]ransgender adolescents were more likely to report bullying at school (41.3% vs 18.0%; aPR, 1.88 [99.75% CI, 1.48-2.38]) and considering (44.8% vs 16.2%; aPR, 1.69 [99.75% CI, 1.41-2.03]), planning (41.6% vs 12.7%; aPR, 1.94 [99.75% CI, 1.57-2.41]), and attempting (30.0% vs 6.9%; aPR, 2.65 [99.75% CI, 1.87-3.74]) suicide than cisgender youths. Gender-questioning adolescents were also more likely to report bullying at school (37.1% vs 18.0%; aPR, 1.62 [99.75% CI, 1.27-2.08]) and considering (43.2% vs 16.2%; aPR, 1.54 [99.75% CI, 1.26-1.89]), planning (37.5% vs 12.7%; aPR, 1.60 [99.75% CI, 1.30-1.96]), and attempting (27.9% vs 6.9%; aPR, 2.26 [99.75% CI, 1.63-3.14]) suicide than cisgender youth.

Transgender and gender questioning youth also reported a higher rate of sexual and dating violence, high risk sexual practices, and substance use compared to their cisgender peers. 

This survey's findings are a call to action for family physicians to support our transgender and gender nonconforming adolescents, but many transgender and gender nonconforming persons avoid healthcare settings due to prior experiences with discrimination. A 2018 AFP editorial outlines strategies family physicians can take to create an equitable environment within their practices, including using inclusive language on intake forms, providing gender neutral bathrooms, and displaying transgender-affirming materials. The editorial also lists resources for family physicians interested in expanding their gender-affirming skill set.

The AAFP actively supports transgender and gender nonconforming persons, affirming that "diversity in gender identity and expression is a normal part of the human existence and does not represent pathology." Unfortunately, legislative initiatives in several US states threaten access to gender-affirming care for over 50,000 transgender youth. This AFP article on "Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know" provides guidance on both care within the office and simple ways to advocate in our communities. This 2019 Community Blog guest post contains additional advocacy tips. And, the AFP By Topic on Special Populations contains a Lesbian, Gay, Bisexual, and Transgender category if you'd like to read more.