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].


  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.
  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.
  3. Olson, J., Forbes, C., Belzer, M. (2011). Management of the transgender adolescent. Archives of Pediatric and Asolescent Medicine. 165(2):171–176.
  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).
  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.
  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.
  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.
  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.
  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
  10. Avila, J. T., Golden, N. H., & Aye, T. (2019). Eating disorder screening in transgender youth. Journal of Adolescent Health, 65(6), 815-817.
  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.
  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.
  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.
  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.
  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.
  16. American Psychological Association (2019). A guide for supporting trans and gender diverse students.
  17. Human Rights Campaign Foundation, American Academy of Pediatrics, & American College of Osteopathic Pediatricians (2016). Supporting and 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.
  19. American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864.
  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.
  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.