Supporting Trans and Non-Binary Adolescents:
What Research Tells Us About Promoting Healthy Development

Authors: Russell B. Toomey (University of Arizona), Alexa Martin-Storey (Université de Sherbrooke), Sharla Biefeld (University of Kentucky), and T. Evan Smith (Elizabethtown College)

Across the United States and around the world, trans and non-binary adolescents are being targeted by policies and laws that restrict their rights to play sports, work with medical professionals to make decisions about their own bodies, and maintain their privacy. While the voices of trans and non-binary adolescents, as well as their parents, teachers and other community allies are clear about the serious negative consequences of these policies and laws,1,2 research can play an important supporting role in helping us to better understand how these types of policies and laws harm trans and non-binary adolescents. Research shows that trans and non-binary adolescents experience more mental health problems and poorer school outcomes when compared to their cisgender (i.e., not trans or non-binary) peers.3–5 Despite these differences, many trans and non-binary adolescents are thriving. Most importantly, research suggests that victimization and discrimination,3,4 parental support,6–8 relationships with teachers,9,10 access to the bathrooms of their choice,11 ability to use a chosen name,12,13 ability to engage in sports,14 and access to gender affirming medical treatment15 are crucial components in determining wellbeing among trans and non-binary adolescents. Said another way, while we cannot overlook the difficulties experienced by many trans and non-binary adolescents, a growing body of research already exists that can help support trans and non-binary adolescents and their allies in underlining the factors that can make their lives better.

The proposed and enacted policies and laws largely affect trans and non-binary adolescents’ rights in three domains: sports, medical care, and privacy. We provide a brief research-based summary of the main questions that arise in policy discussions in each of these three domains next, highlighting (1) why the proposed and enacted policies and laws are harmful, and (2) how to best support and affirm trans and non-binary adolescents.

Trans and Non-Binary Adolescents Deserve Access to Athletics

Proposed and enacted bills at state and local levels seek to ban trans and non-binary adolescents, particularly trans girls, from competing with their athletics teams.

Will participation by trans and non-binary adolescents unfairly reduce access and benefits to cisgender adolescents?

  • Participation in organized athletics enhances adolescents’ psychological and physical health, feelings of connection with school, social skills, and emotion regulation.1
  • Trans and non-binary athletes participate in athletics at lower levels than their cisgender peers,2,3 likely as a result of exclusions or perceived unsafe environments.3
  • There is no evidence that the inclusion of trans and non-binary athletes in athletics reduces participation or benefits of participation for cisgender athletes.4 Indeed, participation by cisgender girls has declined in states where there are trans-exclusive policies or bans.4

Isn’t it too risky for trans and non-binary adolescents to participate in athletics?

  • LGBTQ+ adolescents who do participate in athletics experience enhanced mental health and a greater sense of school belonging. These positive outcomes of sport participation may be even stronger for adolescents who identify as trans and non-binary.3
  • Schools can implement policies and practices to protect the safe use of locker rooms and other school facilities for all students, including trans and non-binary students.3,5 40 – 60% of trans and non-binary adolescents avoid locker rooms, which may limit their participation in athletics.3, 6 When trans and non-binary adolescents feel safer in locker rooms (e.g., able to use a locker room that is consistent with their affirmed gender), they are more likely to participate in athletics.7
Trans and Non-Binary Adolescents Deserve Access to Medical Care

Trans and non-binary adolescents face many obstacles in regard to their healthcare, including financial and familial barriers, and bias and discrimination from health care practitioners.1 Newly proposed and enacted laws ban trans and non-binary adolescents from receiving time-dependent gender affirming medical health care, such as the use of puberty blockers and hormonal therapy.

Is gender affirming medical care safe for adolescents?

  • Both national and international experts recommend that trans adolescents have the option to receive puberty blockers when they are in the early stages of puberty.1, 2, 3 The Endocrine Society and the World Professional Association for Transgender Health (WPATH) both have established guidelines for how to provide these treatments in safe and affirming methods.4
  • The use of hormone therapy by trans adolescents is not associated with higher rates of negative medical outcomes and may prevent the need for future, riskier medical interventions, such as surgery.5, 6
  • Access to gender affirming health care is also associated with positive outcomes. Trans and non-binary adolescents who utilize gender affirming care have less depression and anxiety and have higher gender positivity than their peers who have not been able to access gender affirming care.7 Trans adolescents report more body satisfaction as a result of receiving gender affirming medical care.8 Accessing gender affirming medical care is also associated with higher self-esteem.8 Longitudinal studies suggest that adolescents who receive gender affirming medical also have better psychological function in adulthood.9

Why can’t adolescents just wait until adulthood?

  • Lack of access to gender affirming care and practices during puberty is dangerous, for both mental and physical health. When adolescents cannot access puberty blockers and gender affirming hormones they may experience irreversible changes to their body, and some of the gender affirming interventions in adulthood to address these changes often carry higher risks.10, 11, 12
  • Forcing adolescents to wait until adulthood may result in adolescents feeling a loss of autonomy, which is related to many negative mental health outcomes, including increased suicide ideation.4,11 Research also suggests that accessing gender affirming health care later in adolescence is associated with worse psychological well-being, than when adolescents access this care earlier.13

Can adolescents make these important healthcare decisions?

  • Research suggests that trans adolescents do have the capacity to make important health-care decisions in concert with their doctor.12 The United Nations Convention on the Rights of the Child argues that adolescents should have the right to make healthcare decisions once they have the capacity to do so (United Nations, 1989).
  • Healthcare providers that work with trans adolescents argue that their patients are mature enough to understand the medical information they are given, and often spend a great deal of time thinking about and discussing gender affirming care with their doctors and loved ones before making a decision.12
  • Adolescent impulsivity has also been discussed as reason to withhold gender affirming care; however, impulsive decisions by adolescents usually occur in situations that require a quick decision, are characterized by high emotion, and where adolescents are directly impacted by peer influence.14, 15 This is not the case when adolescents seek out medical gender affirming care. Instead, adolescents often do extensive research prior to meeting with their healthcare provider, then further discuss options with their provider, including benefits and risks, and discuss these options with loved ones. This process may be repeated multiple times before any decisions are made.
  • Many children recognize that they are trans or non-binary early in life, often prior to telling others, and many adolescents have begun to socially transition prior to seeking out medically affirming gender care (although trajectories do differ). The majority of adolescents who seek out this care have often thought long and hard about the decision to seek gender affirming medical care.12, 16, 17

Will adolescents regret their decision to medically transition/want to “detransition”?

  • “De-transition”, is extremely rare among individuals who have identified as trans at some point in their life or have sought gender-affirming medical care.18, 19, 20, 21
  • Among the small percentage of people who do “de-transition”, the majority discuss external factors as main contributors to their decision, such as pressure from others, discrimination, lack of financial resources, and lack of medical insurance coverage, etc. 25, 22
Trans and Non-Binary Adolescents Deserve Privacy

Proposed laws in several jurisdictions seek to require school personnel and other government employees to disclose an adolescent’s gender identity or expression to the adolescent’s parents or guardians or to other students and other students’ parents.

Don’t parents have a right to know this information about their adolescent?

  • Mandatory reporting of a student’s gender identity or expression to parents or guardians can place trans and non-binary adolescents at risk for harm. Many (30-50%) trans and non-binary adolescents do not have supportive family members at initial disclosure.23
  • Disclosure by others (rather than the trans or non-binary adolescent) to family members may result in rejection, violence, and homelessness. Family rejection is associated with increased risk for suicidality, substance use, and depressive and anxiety symptoms.24, 25
  • Nearly 40% adolescents experiencing homelessness are sexual or gender minority adolescents; family rejection of adolescents’ gender or sexuality is the primary reason for experiencing homelessness among sexual and gender minority adolescents.26

Shouldn’t other students or other students’ parents know that they/their student are in class with a trans or non-binary student?

  • FERPA (federal education privacy law) prohibits school personnel from sharing student’s private information, such as a student’s trans status, to anyone other than the student’s parents unless the student has given the school permission to share the information with others.27
  • Sharing this information with other students or students’ family members may place trans and non-binary adolescents at greater risk for peer victimization in schools. Science clearly documents that the majority of trans and non-binary adolescents already experience victimization and violence at school related to their gender identity or expression, and that these experiences are associated with suicidality, depression, school absenteeism, dropout, and low grades.28

Suggested Resources:

Society for Research on Adolescence: Resources for Understanding the Transgender Child and Family Experience

Human Rights Campaign: Parents for Transgender Equality National Council

National Center for Transgender Equality: Know Your Rights - Schools

GLSEN: Gender Affirming and Inclusive Athletics Participation

 References: Introduction
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