Articles & Resources

Society for Health Psychology

Working with Transgender Adolescents and Young Adults (AYA)

Adolescent/Young Adult, Diversity & Multiculturalism

Download a PDF of this Fact Sheet here!

Transgender and gender diverse youth are a rapidly growing, underserved population with significant psychological and health disparities.

Psychological Disparities

Compared to cisgender peers, transgender youth…

  • Report higher levels of anxiety, depression, and co-occurring psychiatric disorders [1-5].
  • Are 2 to 4 times more likely to experience substance misuse (depending on substance) [6].
  • Have more frequent self-harm [7], suicidal ideation and suicide attempts [8,9].
  • Show higher rates of disordered eating behaviors [10].

Health Disparities

Compared to cisgender peers, transgender youth…

  • Report poorer overall health, lower rates of preventative health check-ups, and more frequent emergency room avoidance [11].
  • Show increased risk for acquiring sexually transmitted infections and HIV [12].
  • Experience elevated rates of high blood pressure and asthma and poorer physical health that kept them from doing their usual activities [13].

Providing Gender—Affirmative Care

Having a gender-affirming provider is associated with significant decreases in lifetime depression and suicidality [14]. Gender-affirming providers…

  1. Set the stage at intake that providers are always open to gender/pronouns changing.
  2. Maintain a non-judgmental stance that is supportive and free of stigma.
  3. Frequently assess AYA’s pronouns and gender identity.
  4. If a provider accidentally misgenders a patient (i.e., uses the incorrect pronoun), self-correct with the patient’s pronouns without excessive apologies that put the AYA in a position of having to absolve/forgive the provider.
Setting the Stage:

“Over the course of our work together, you may experience changes in your gender identity or your pronouns, which is completely normal. I will check in about this periodically, and, of course, you can always let me know anytime things change.”

Learn more about gender-affirmative care:

Establishing Supportive Facilities

  • Provide gender-neutral bathrooms.
  • Place LGBTQ+ magazines, posters, or flyers in your waiting room.
  • Employ staff who have received diversity training in LGBTQ+ issues and provide regular diversity trainings.
  • Ensure your intake forms are inclusive of trans identities.
  • Use patient-asserted name and pronouns in electronic health records, billing systems, notification systems, and clinical research.
  • Include pronouns on staff badges and in email signatures.
  • Introduce yourself (and others, when relevant) using their pronouns.
  • Utilize appropriate instruments if assessing aspects of trans and gender non-conforming patients’ adjustment and functioning [21].

References:

  1. De Vries, A., Doreleijers, T., Steensma, T., & Cohen‐Kettenis, P. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52(11), 1195–1202. https://doi.org/10.1111/j.1469-7610.2011.02426.x
  2. Gridley, S., Crouch, J., Evans, Y., Eng, W., Antoon, E., Lyapustina, M., … Breland, D. (2016). Youth and caregiver perspectives on barriers to gender-affirming health care for transgender youth. Journal of Adolescent Health, 59(3), 254–261. https://doi.org/10.1016/j.jadohealth.2016.03.017
  3. Olson, J., Forbes, C., Belzer, M. (2011). Management of the transgender adolescent. Archives of Pediatric and Asolescent Medicine. 165(2):171–176. https://doi.org/10.1001/archpediatrics.2010.275
  4. Rider, G. N., McMorris, B. J., Gower, A. L., Coleman, E., & Eisenberg, M. E. (2018). Health and care utilization of transgender and gender nonconforming youth: A population-based study. Pediatrics, 141(3). https://doi.org/10.1542/peds.2017-1683
  5. Society for Adolescent Health and Medicine (2013). Recommendations for promoting the health and well-being of lesbian, gay, bisexual, and transgender adolescents: A position paper of the society for adolescent health and medicine. Journal of Adolescent Health, 52(4): 506-510. https://doi.org/10.1016/j.jadohealth.2013.01.015
  6. Day, J. K., Fish, J. N., Perez-Brumer, A., Hatzenbuehler, M. L., & Russell, S. T. (2017). Transgender Youth Substance Use Disparities: Results From a Population-Based Sample. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 61(6), 729–735. https://doi.org/10.1016/j.jadohealth.2017.06.024
  7. Arcelus, J., Claes, L., Witcomb, G. L., Marshall, E., & Bouman, W. P. (2016). Risk factors for non-suicidal self-injury among trans youth. The Journal of Sexual Medicine, 13(3), 402-412. https://doi.org/10.1016/j.jsxm.2016.01.003
  8. Thoma, B. C., Salk, R. H., Choukas-Bradley, S., Goldstein, T. R., Levine, M. D., & Marshal, M. P. (2019). Suicidality Disparities Between Transgender and Cisgender Adolescents. Pediatrics, 144(5), e20191183. https://doi.org/10.1542/peds.2019-1183
  9. Herman, J. L, Brown, T. N, & Haas, A. P. (2019). Suicide Thoughts and Attempts Among Transgender Adults: Findings from the 2015 U.S. Transgender Survey. UCLA: The Williams Institute. Retrieved from https://escholarship.org/uc/item/1812g3hm
  10. Avila, J. T., Golden, N. H., & Aye, T. (2019). Eating disorder screening in transgender youth. Journal of Adolescent Health, 65(6), 815-817. https://doi.org/10.1016/j.jadohealth.2019.06.011
  11. Bauer G, Scheim A, Deutsch M, et al. Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. Ann Emerg Med 2014;63:713–20. https://doi.org/10.1016/j.annemergmed.2013.09.027
  12. Fisher, C. B., Fried, A. L., Desmond, M., Macapagal, K., & Mustanski, B. (2018). Perceived barriers to HIV prevention services for transgender youth. LGBT health, 5(6), 350-358. https://doi.org/10.1089/lgbt.2017.0098
  13. Seelman, K. L., Young, S. R., Tesene, M., Alvarez-Hernandez, L. R., & Kattari, L. (2017). A comparison of health disparities among transgender adults in Colorado (USA) by race and income. International Journal of Transgenderism, 18(2), 199-214. https://doi.org/10.1080/15532739.2016.1252300
  14. Kattari, S., Walls, N., Speer, S., & Kattari, L. (2016). Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people. Social Work in Health Care, 55(8),635–650. https://doi.org/10.1080/00981389.2016.1193099
  15. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., . . . Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165–232. https://doi.org/10.1080/15532739.2011.700873
  16. American Psychological Association (2019). A guide for supporting trans and gender diverse students. https://www.apa.org/apags/governance/subcommittees/supporting-diverse-students.pdf
  17. Human Rights Campaign Foundation, American Academy of Pediatrics, & American College of Osteopathic Pediatricians (2016). Supporting and caring for transgender children. https://www.hrc.org/resources/supporting-caring-for-transgender-children
  18. Keo-Meier, C., & Ehrensaft, D. (Eds.). (2018). Perspectives on sexual orientation and diversity. The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children. American Psychological Association. https://doi.org/10.1037/0000095-000
  19. American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864. http://dx.doi.org/10.1037/a0039906
  20. Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460–467. https://doi.org/10.1037/a0029597
  21. Shulman, G. P., Holt, N. R., Hope, D. A., Mocarski, R., Eyer, J., & Woodruff, N. (2017). A Review of Contemporary Assessment Tools for Use with Transgender and Gender Nonconforming Adults. Psychology of sexual orientation and gender diversity, 4(3), 304–313. https://doi.org/10.1037/sgd0000233
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