A transgender woman in a hospital gown speaking to her doctor, a transgender man, in an exam room. Image by Zackary Drucker for the Gender Spectrum Collection
Image by Zackary Drucker for Broadly's Gender Spectrum Collection

Background: Research suggests that transgender and gender diverse youth may be at greatly increased risk of high-risk health behaviors compared with cisgender youth, but existing studies are limited by convenience samples and small numbers. This study used a large school-based sample of adolescents to describe the prevalence of gender diverse identities, associations with health risk behaviors and protective factors, and differences across birth-assigned sex. The goal of this mixed-methods study is to understand the health needs of gender diverse youth in order to develop and test training modules to be used in medical and nursing education in future studies.

This study: This research includes extensive analysis of a large, population-based sample of gender diverse youth (N=2168), takes a broad view of health influences and health care, and pairs this information with qualitative data from adolescent health care providers and youth. 

Qualitative Research: The aim of this component was to understand health care practices and needs of this gender diverse youth by conducting interviews with both the youth themselves and the healthcare providers who treat them. Interviews with health care providers included questions about their professional training regarding gender diverse youth, need for resources, and comfort and competence with this topic. Interviews with gender diverse youth included questions regarding their experiences with health care professionals, information they would share with providers about their health needs, and feedback on findings from health care provider interviews.

Quantitative Research: The aim of this component was to analyze data from the Minnesota Student Survey (MSS), a voluntary survey administered statewide to Minnesotan secondary school students which surveils adolescents’ health and related behaviors. In recent years, the MSS has been revised to include three measures regarding gender (biological sex, transgender identity, and gender presentation).  Analyses focused on high risk health behaviors (i.e. substance use, sex behaviors, suicide involvement, bullying and bias-based victimization), protective factors (i.e. internal assets, family support, school connection), health and health care utilization of gender variant youth, with comparisons to straight cisgender youth and youth who are diverse and lesbian, gay, bisexual and questioning (LGBQ, with whom transgender youth are often grouped for services and resources). Key findings from these analyses included:

  • 2.7% of Minnesota 9th and 11th graders identified themselves as transgender, genderqueer, gender fluid or unsure about their gender identity on the survey.
  • This percentage was consistent among young people in the Twin Cities metro area and across the state.
  • Disparities for gender diverse young people were significant:
    • 2/3 of gender diverse youth reported thoughts of suicide, 3 times more than their cisgender peers.
    • 1/3 of gender diverse youth reported a suicide attempt: 5 times more than their cisgender peers.
    • Over 1/3 of gender diverse youth reported prejudice-based bullying about their gender: 7 times greater than their cisgender peers.
  • Gender diverse youth had important strengths and assets, although fewer than their cisgender peers:
    • 71% of gender diverse youth reported that they could talk to at least one parent about their problems (compared to 90% of cisgender youth).
    • 59% of gender diverse youth reported that teachers or other school adults cared about them (compared to 77% of cisgender youth.)
  • 62.1% of gender diverse youth reported their general health as poor, fair, or good versus very good or excellent, compared with 33.1% of cisgender youth.

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R21HD088757.